Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 937, S3-28 | NV |
NPI | 1053497768 |
---|---|
Provider Name | Dr. Lance Loren Whetten |
First Address | Las Vegas, NV 89121-5923 |
Second Address | Las Vegas, NV 89121-5923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 08/07/2007 |