Basic Information
| Provider Information | |||||||||
| NPI: | 1003008012 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITEMAN | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | R. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.D.S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 515 3RD ST | ||||||||
| Address2: | |||||||||
| City: | NIAGARA FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 143011507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7162853588 | ||||||||
| FaxNumber: | 7162851083 | ||||||||
| Practice Location | |||||||||
| Address1: | 515 3RD ST | ||||||||
| Address2: | |||||||||
| City: | NIAGARA FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 143011507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7162853588 | ||||||||
| FaxNumber: | 7162851083 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2007 | ||||||||
| LastUpdateDate: | 08/14/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | 028190-1 | NY | Y | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
No ID Information.