Individual
KEITH J WHITTEMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3120 KIMBALL AVE, WATERLOO, IA 50702-5272
(319) 232-1354
(319) 232-2082
Mailing address
3120 KIMBALL AVE, WATERLOO, IA 50702-5272
(319) 232-1354
(319) 232-2082
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
07395
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0282517
—
IA
Enumeration date
02/09/2007
Last updated
07/09/2007
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