Provider Demographics
NPI:1821473851
Name:DEITZ, WHITNEY LEANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:WHITNEY
Middle Name:LEANN
Last Name:DEITZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5035 FREDERICA STREET
Mailing Address - Street 2:SUITE 3
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301
Mailing Address - Country:US
Mailing Address - Phone:270-686-1636
Mailing Address - Fax:270-686-5930
Practice Address - Street 1:5035 FREDERICA STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301
Practice Address - Country:US
Practice Address - Phone:270-686-1636
Practice Address - Fax:270-686-5930
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY96191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice