Provider Demographics
NPI:1932520707
Name:JON L. WHITELEY, DDS, PC
Entity Type:Organization
Organization Name:JON L. WHITELEY, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:WHITELEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-321-0828
Mailing Address - Street 1:3300 E 1ST AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5809
Mailing Address - Country:US
Mailing Address - Phone:303-321-0828
Mailing Address - Fax:303-321-0027
Practice Address - Street 1:3300 E 1ST AVE STE 500
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5809
Practice Address - Country:US
Practice Address - Phone:303-321-0828
Practice Address - Fax:303-321-0027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-22
Last Update Date:2013-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO105400261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental