Provider Demographics
NPI:1124142005
Name:WHITTERN, CATHY DAWN (DDS)
Entity type:Individual
Prefix:DR
First Name:CATHY
Middle Name:DAWN
Last Name:WHITTERN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CATHY
Other - Middle Name:DAWN
Other - Last Name:STEPHENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:13876 ELMORE RD
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-9309
Mailing Address - Country:US
Mailing Address - Phone:303-678-7558
Mailing Address - Fax:303-678-8422
Practice Address - Street 1:13876 ELMORE RD
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-9309
Practice Address - Country:US
Practice Address - Phone:303-678-7558
Practice Address - Fax:303-678-8422
Is Sole Proprietor?:No
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO65921223G0001X
MN100891223G0001X
IA72321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice