Organization
KEITH J. WHITTEMORE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEITH J. WHITTEMORE D.D.S. (OWNER)
(319) 232-1354
Entity
Organization
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
03/19/2007
Last updated
08/22/2020
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