Provider Demographics
NPI:1396150710
Name:SMITH, WHITNEY KITCHELL (DDS)
Entity type:Individual
Prefix:DR
First Name:WHITNEY
Middle Name:KITCHELL
Last Name:SMITH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:WHITNEY
Other - Middle Name:KITCHELL
Other - Last Name:LAVERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2457 OAKMONT WAY
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6460
Mailing Address - Country:US
Mailing Address - Phone:541-484-2046
Mailing Address - Fax:541-683-5333
Practice Address - Street 1:1640 G ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-4226
Practice Address - Country:US
Practice Address - Phone:541-484-2046
Practice Address - Fax:541-683-5333
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012156A122300000X
CODEN00202841122300000X
ORD11417122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist