Provider Demographics
NPI:1487147914
Name:WHITING, ERIC
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:WHITING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2568 N LAKE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-4091
Mailing Address - Country:US
Mailing Address - Phone:801-380-5279
Mailing Address - Fax:
Practice Address - Street 1:2618 W 7800 S STE 100
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-4212
Practice Address - Country:US
Practice Address - Phone:801-380-5279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-09
Last Update Date:2020-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11722037-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist