Provider Demographics
NPI:1568021871
Name:WHISENANT, EVAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:
Last Name:WHISENANT
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 1:13730 SW WEIR RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-8063
Mailing Address - Country:US
Mailing Address - Phone:503-608-2405
Mailing Address - Fax:
Practice Address - Street 1:13730 SW WEIR RD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-8063
Practice Address - Country:US
Practice Address - Phone:503-608-2405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD110601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice