Provider Demographics
NPI:1477692200
Name:WHALEN, JAMES VICTOR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:VICTOR
Last Name:WHALEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9450 DEL WEBB BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-8314
Mailing Address - Country:US
Mailing Address - Phone:702-255-2111
Mailing Address - Fax:702-255-8075
Practice Address - Street 1:9450 DEL WEBB BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-8314
Practice Address - Country:US
Practice Address - Phone:702-255-2111
Practice Address - Fax:702-255-8075
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV23961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice