Provider Demographics
NPI:1326459769
Name:HAIDET, WHITNEY (DMD)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:HAIDET
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 1:21300 TOWN COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-3468
Mailing Address - Country:US
Mailing Address - Phone:239-676-1368
Mailing Address - Fax:239-676-1373
Practice Address - Street 1:21300 TOWN COMMONS DR
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-3468
Practice Address - Country:US
Practice Address - Phone:239-676-1368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21229122300000X
FL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program