Individual
DR. TYLER BRENT WHITING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD, BS
Contact information
Practice address
4122 QUEST DR, EUGENE, OR 97402
(541) 844-1667
(541) 505-8463
Mailing address
4122 QUEST DR, EUGENE, OR 97402-8768
(541) 844-1667
(541) 505-8463
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
10985
OR
1223P0221X
Pediatric Dentistry
D009666
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D09666
DENTAL LICENSE
AZ
01
—
D10985
DENTAL LICENSE
OR
Enumeration date
03/23/2015
Last updated
07/19/2019
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