Provider Demographics
NPI:1427365899
Name:WHITEFIELD, QUINT ALLEN (DDS)
Entity Type:Individual
Prefix:
First Name:QUINT
Middle Name:ALLEN
Last Name:WHITEFIELD
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 1:1618 N. 5TH STREET
Mailing Address - Street 2:SUITE #2
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601
Mailing Address - Country:US
Mailing Address - Phone:580-762-5624
Mailing Address - Fax:580-762-5644
Practice Address - Street 1:1618 N. 5TH STREET
Practice Address - Street 2:SUITE #2
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601
Practice Address - Country:US
Practice Address - Phone:580-762-5624
Practice Address - Fax:580-762-5644
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK50371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice