Provider Demographics
NPI:1659387751
Name:JARRELL, WHITNEY SHAUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:WHITNEY
Middle Name:SHAUN
Last Name:JARRELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3903 FAIR RIDGE DR STE 214
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2945
Mailing Address - Country:US
Mailing Address - Phone:703-263-9388
Mailing Address - Fax:703-877-0776
Practice Address - Street 1:3903 FAIR RIDGE DR STE 214
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2945
Practice Address - Country:US
Practice Address - Phone:703-263-9388
Practice Address - Fax:703-887-0776
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014108931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9181203Medicaid