Provider Demographics
NPI:1194275792
Name:HEWITT, WHITNEY NICOLE DEFOREST (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:WHITNEY
Middle Name:NICOLE DEFOREST
Last Name:HEWITT
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 OFALLON COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-7931
Mailing Address - Country:US
Mailing Address - Phone:636-978-9585
Mailing Address - Fax:
Practice Address - Street 1:103 OFALLON COMMONS DR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7931
Practice Address - Country:US
Practice Address - Phone:636-978-9585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20140167691223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics