Provider Demographics
NPI:1306903026
Name:WHITFIELD, DOUGLAS FARRELLY (DDS)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:FARRELLY
Last Name:WHITFIELD
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 1:22142 SE 237TH ST, SUITE A
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-5510
Mailing Address - Country:US
Mailing Address - Phone:425-432-1292
Mailing Address - Fax:425-432-0192
Practice Address - Street 1:22142 SE 237TH ST, SUITE A
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-5510
Practice Address - Country:US
Practice Address - Phone:425-432-1292
Practice Address - Fax:425-432-0192
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010306122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist