Provider Demographics
NPI:1700217841
Name:WHITEHEAD, GEORGE M (DDS)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:M
Last Name:WHITEHEAD
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 1:222 EAST FIRST STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520
Mailing Address - Country:US
Mailing Address - Phone:360-533-2726
Mailing Address - Fax:360-532-9915
Practice Address - Street 1:222 EAST FIRST STREET
Practice Address - Street 2:SUITE B
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520
Practice Address - Country:US
Practice Address - Phone:360-533-2726
Practice Address - Fax:360-532-9915
Is Sole Proprietor?:No
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000052041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice