Provider Demographics
NPI:1619147261
Name:WHITTEMORE, DAVID KEITH (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:KEITH
Last Name:WHITTEMORE
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 1:3120 KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5272
Mailing Address - Country:US
Mailing Address - Phone:319-232-1354
Mailing Address - Fax:319-232-2082
Practice Address - Street 1:3120 KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5272
Practice Address - Country:US
Practice Address - Phone:319-232-1354
Practice Address - Fax:319-232-2082
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA5479122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist