Provider Demographics
NPI:1538304555
Name:WHITEMARSH, DANIEL KEITH (DMD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:KEITH
Last Name:WHITEMARSH
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 1:311 EAST 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:CLE ELUM
Mailing Address - State:WA
Mailing Address - Zip Code:98922
Mailing Address - Country:US
Mailing Address - Phone:509-674-2307
Mailing Address - Fax:509-674-7330
Practice Address - Street 1:311 E 1ST ST
Practice Address - Street 2:
Practice Address - City:CLE ELUM
Practice Address - State:WA
Practice Address - Zip Code:98922-1201
Practice Address - Country:US
Practice Address - Phone:509-674-2307
Practice Address - Fax:509-674-7330
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60006068122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist