Provider Demographics
NPI:1275780439
Name:WHETTEN, JASON K (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:K
Last Name:WHETTEN
Suffix:
Gender:M
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:PO BOX 1319
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85132-3026
Mailing Address - Country:US
Mailing Address - Phone:520-868-3384
Mailing Address - Fax:520-868-1200
Practice Address - Street 1:495 N PINAL PKWY STE 101
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85132-8870
Practice Address - Country:US
Practice Address - Phone:480-202-0992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD7646122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist