Provider Demographics
NPI:1114179777
Name:WHITT, COLLEEN ANN (BS, RDH)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ANN
Last Name:WHITT
Suffix:
Gender:F
Credentials:BS, RDH
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:ANN
Other - Last Name:PALMIERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, RDH
Mailing Address - Street 1:11092 ANDERSON STREET
Mailing Address - Street 2:LLU SCHOOL OF DENTISTRY
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92350-0001
Mailing Address - Country:US
Mailing Address - Phone:909-558-4613
Mailing Address - Fax:909-558-4192
Practice Address - Street 1:11092 ANDERSON STREET
Practice Address - Street 2:LLU SCHOOL OF DENTISTRY
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92350-0001
Practice Address - Country:US
Practice Address - Phone:909-558-4613
Practice Address - Fax:909-558-4192
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDH 17152124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARDH 17152OtherSTATE LICENSE