Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 8100 | GA |
NPI | 1013053180 |
---|---|
Provider Name | Daniel Whitner |
First Address | Kennesaw, GA 30144-7080 |
Second Address | Kennesaw, GA 30144-7080 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 08/07/2007 |