Provider Demographics
NPI:1972766178
Name:WHITING, LARRY DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:DAVID
Last Name:WHITING
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 1:660 N CENTRAL EXPWY
Mailing Address - Street 2:SUITE 644
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-6760
Mailing Address - Country:US
Mailing Address - Phone:972-881-7550
Mailing Address - Fax:972-422-1552
Practice Address - Street 1:660 N CENTRAL EXPWY
Practice Address - Street 2:SUITE 644
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-6760
Practice Address - Country:US
Practice Address - Phone:972-881-7550
Practice Address - Fax:972-422-1552
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14009122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX091049902Medicaid