Provider Demographics
NPI:1326771270
Name:PAUL D WHITNEY DDS PC
Entity Type:Organization
Organization Name:PAUL D WHITNEY DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:G
Authorized Official - Last Name:WHITNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-853-1601
Mailing Address - Street 1:5200 E CORTLAND BLVD STE C4
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-9341
Mailing Address - Country:US
Mailing Address - Phone:928-526-4314
Mailing Address - Fax:
Practice Address - Street 1:5200 E CORTLAND BLVD STE C4
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-9341
Practice Address - Country:US
Practice Address - Phone:928-526-4314
Practice Address - Fax:928-714-1475
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAUL D WHITNEY DDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental