Provider Demographics
NPI:1144386160
Name:WHITEHEAD, DAVID EARLE JR (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:EARLE
Last Name:WHITEHEAD
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 SEYMOUR STREET
Mailing Address - Street 2:SUITE 1018
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106
Mailing Address - Country:US
Mailing Address - Phone:860-251-6999
Mailing Address - Fax:860-251-6997
Practice Address - Street 1:85 SEYMOUR STREET
Practice Address - Street 2:SUITE 1018
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106
Practice Address - Country:US
Practice Address - Phone:860-251-6999
Practice Address - Fax:860-251-6997
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7277122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist