Provider Demographics
NPI:1558622084
Name:WHITTINGTON, CANDACE ELEASE (DMD)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:ELEASE
Last Name:WHITTINGTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:579 OAKLYNN CT APT 1A
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-4226
Mailing Address - Country:US
Mailing Address - Phone:305-206-3124
Mailing Address - Fax:
Practice Address - Street 1:501 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:CENTURY
Practice Address - State:FL
Practice Address - Zip Code:32535
Practice Address - Country:US
Practice Address - Phone:850-256-6203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN196391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice