Provider Demographics
NPI:1912095126
Name:WHELAN, GREGORY (DMD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:WHELAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9840 W YEARLING RD
Mailing Address - Street 2:#1240
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-1377
Mailing Address - Country:US
Mailing Address - Phone:623-572-9300
Mailing Address - Fax:
Practice Address - Street 1:9840 W YEARLING RD
Practice Address - Street 2:#1240
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-1377
Practice Address - Country:US
Practice Address - Phone:623-572-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0150951223P0221X
AZ74711223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry