Provider Demographics
NPI:1326158171
Name:MCWHINNEY, JON CAMPBELL (DDS)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:CAMPBELL
Last Name:MCWHINNEY
Suffix:
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 1:4332 CENTER POINT ROAD NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-3015
Mailing Address - Country:US
Mailing Address - Phone:319-393-1736
Mailing Address - Fax:
Practice Address - Street 1:4332 CENTER POINT ROAD NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-3015
Practice Address - Country:US
Practice Address - Phone:319-393-1736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA5460122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0028498Medicaid