Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DEN8212 | CO |
NPI | 1104931674 |
---|---|
Provider Name | Scott I Whitney |
First Address | Centennial, CO 80112-2368 |
Second Address | Centennial, CO 80112-2368 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 27/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BW7040607 | DEA (01) | CO |