Provider Demographics
NPI:1184898165
Name:DR. DALE C. WHILDEN, LLC
Entity type:Organization
Organization Name:DR. DALE C. WHILDEN, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SINGLE MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:C
Authorized Official - Last Name:WHILDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-774-8700
Mailing Address - Street 1:64 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:OCEAN GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07756-1319
Mailing Address - Country:US
Mailing Address - Phone:732-774-8700
Mailing Address - Fax:732-774-8708
Practice Address - Street 1:64 MAIN AVE
Practice Address - Street 2:
Practice Address - City:OCEAN GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07756-1319
Practice Address - Country:US
Practice Address - Phone:732-774-8700
Practice Address - Fax:732-774-8708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-21
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01229500261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental