Provider Demographics
NPI:1215156914
Name:WHITNEY, HAL P (DDS)
Entity type:Individual
Prefix:DR
First Name:HAL
Middle Name:P
Last Name:WHITNEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1977 S HAVANA ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1011
Mailing Address - Country:US
Mailing Address - Phone:303-752-8813
Mailing Address - Fax:303-751-0666
Practice Address - Street 1:1977 S HAVANA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1011
Practice Address - Country:US
Practice Address - Phone:303-752-8813
Practice Address - Fax:303-751-0666
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO063801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO13207857Medicaid
CO06380OtherDENTAL LICENSE