Provider Demographics
NPI:1952593857
Name:WHITLOCK, DAVID RICHARDSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RICHARDSON
Last Name:WHITLOCK
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 1:2072 E SOUTHERN AVE
Mailing Address - Street 2:SUITE A102
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7595
Mailing Address - Country:US
Mailing Address - Phone:480-699-5093
Mailing Address - Fax:480-704-3093
Practice Address - Street 1:2072 E SOUTHERN AVE
Practice Address - Street 2:SUITE A102
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7595
Practice Address - Country:US
Practice Address - Phone:480-699-5093
Practice Address - Fax:480-704-3093
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD72441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice