Doctor Name: | STEPHEN PAUL WHOOLERY |
NPI Number: | 1164747812 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.D.S. |
License Number: | D9505 |
Business Practice Address: | 219 E Lincoln Ave Fergus Falls, MN - 565372236 |
Business Phone Number: | 2187392217 |
Business Fax Number: | 2187392443 |
Mailing Address: | 219 E Lincoln Ave, FERGUS FALLS |
State: | MN |
Postal Code: | 565372236 |
Phone Number: | 2187392217 |
Fax Number: | 2187392443 |
NPI Enumeration Date: | 04/06/2010 |
NPI Last Update Date: | 05/29/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1223P0221X |
License Number: | D9505 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Dentist |
Taxonomy Specialization: | Pediatric Dentistry |
Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |