Provider Demographics
NPI:1164756078
Name:WHELAN, MICHAEL F (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:F
Last Name:WHELAN
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19625 68TH AVE W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5909
Mailing Address - Country:US
Mailing Address - Phone:425-778-5991
Mailing Address - Fax:425-778-5910
Practice Address - Street 1:19625 68TH AVE W
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5909
Practice Address - Country:US
Practice Address - Phone:425-778-5991
Practice Address - Fax:425-778-5910
Is Sole Proprietor?:No
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA82811223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG74484Medicare UPIN
WAAB32633Medicare PIN