Provider Demographics
NPI:1255546537
Name:WHALEN, LUKE ARTHUR (DDS)
Entity type:Individual
Prefix:DR
First Name:LUKE
Middle Name:ARTHUR
Last Name:WHALEN
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 1:116 W BULLION ST
Mailing Address - Street 2:
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333-8425
Mailing Address - Country:US
Mailing Address - Phone:208-788-4507
Mailing Address - Fax:208-788-6445
Practice Address - Street 1:116 W BULLION ST
Practice Address - Street 2:
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-8425
Practice Address - Country:US
Practice Address - Phone:208-788-4507
Practice Address - Fax:208-788-6445
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD1485122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist