Provider Demographics
NPI:1740675289
Name:WHITNEY, JOSEPH (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:WHITNEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SIMMONS ST
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-1019
Mailing Address - Country:US
Mailing Address - Phone:774-249-8492
Mailing Address - Fax:
Practice Address - Street 1:130 CABOT ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-5143
Practice Address - Country:US
Practice Address - Phone:978-279-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-01
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT138846634390200000X
MA18571631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program