Provider Demographics
NPI:1366836835
Name:WHITING, TYLER BRENT (DMD, BS)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:BRENT
Last Name:WHITING
Suffix:
Gender:M
Credentials:DMD, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4122 QUEST DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-8768
Mailing Address - Country:US
Mailing Address - Phone:541-844-1667
Mailing Address - Fax:541-505-8463
Practice Address - Street 1:4122 QUEST DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402
Practice Address - Country:US
Practice Address - Phone:541-844-1667
Practice Address - Fax:541-505-8463
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZD0096661223P0221X
OR109851223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD09666OtherDENTAL LICENSE
ORD10985OtherDENTAL LICENSE