Provider Demographics
NPI:1255320487
Name:BERENS, WHITNEY BROOKE (DMD)
Entity Type:Individual
Prefix:DR
First Name:WHITNEY
Middle Name:BROOKE
Last Name:BERENS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1953 POTTERY AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-2558
Mailing Address - Country:US
Mailing Address - Phone:360-876-6211
Mailing Address - Fax:
Practice Address - Street 1:1953 POTTERY AVE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-2558
Practice Address - Country:US
Practice Address - Phone:360-876-6211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010035122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist