Individual
DR. WARREN L WHITNAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
PINE EAGLE CLINIC, 218 N. PINE STREET, HALFWAY, OR 97870
(541) 742-6012
(541) 742-6013
Mailing address
35555 SPARTA LN, RICHLAND, OR 97870-6650
(541) 893-6012
(541) 893-6787
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4377
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0636682-6
SID#
OR
01
—
210013
OMAP PROVIDER #
OR
01
—
356545
DRIVERS LICENSE #
OR
01
—
4377
DENTAL LICENSE #
OR
Enumeration date
01/30/2007
Last updated
07/08/2007
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