Provider Demographics
NPI:1578847620
Name:DANIEL WHITEMARSH DMD, P.S., INC.
Entity Type:Organization
Organization Name:DANIEL WHITEMARSH DMD, P.S., INC.
Other - Org Name:CLE ELUM DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:WHITEMARSH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:509-374-7245
Mailing Address - Street 1:311 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CLE ELUM
Mailing Address - State:WA
Mailing Address - Zip Code:98922-1201
Mailing Address - Country:US
Mailing Address - Phone:509-674-2307
Mailing Address - Fax:509-674-7330
Practice Address - Street 1:311 E 1ST ST
Practice Address - Street 2:
Practice Address - City:CLE ELUM
Practice Address - State:WA
Practice Address - Zip Code:98922-1201
Practice Address - Country:US
Practice Address - Phone:509-674-2307
Practice Address - Fax:509-674-7330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60006068305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization