Provider Demographics
NPI:1376615609
Name:DANNY L WHITING DDS PC
Entity Type:Organization
Organization Name:DANNY L WHITING DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:LAVERN
Authorized Official - Last Name:WHITING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:712-258-5057
Mailing Address - Street 1:2910 HAMILTON BLVD
Mailing Address - Street 2:STE. 102
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-2423
Mailing Address - Country:US
Mailing Address - Phone:712-258-5057
Mailing Address - Fax:712-258-7963
Practice Address - Street 1:2910 HAMILTON BLVD
Practice Address - Street 2:STE. 102
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-2423
Practice Address - Country:US
Practice Address - Phone:712-258-5057
Practice Address - Fax:712-258-7963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA5870122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA01119156Medicaid