Provider Demographics
NPI:1720165905
Name:HUSTAD DAVIDSON, WHITNEY CHRISTINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:WHITNEY
Middle Name:CHRISTINE
Last Name:HUSTAD DAVIDSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:WHITNEY
Other - Middle Name:CHRISTINE
Other - Last Name:HUSTAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:906 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812-1113
Mailing Address - Country:US
Mailing Address - Phone:218-606-1040
Mailing Address - Fax:218-606-1060
Practice Address - Street 1:906 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812-1113
Practice Address - Country:US
Practice Address - Phone:218-606-1040
Practice Address - Fax:218-606-1060
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN122421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN904481047559OtherPREFERRED ONE
MN276999900Medicaid
MN97G02HUOtherBCBSMN
MN1858670OtherUNITED CONCORDIA
MNHP65362OtherHEALTH PARTNERS