Provider Demographics
NPI:1447301387
Name:WHITNEY, CARLENE ANNE (DDS)
Entity type:Individual
Prefix:DR
First Name:CARLENE
Middle Name:ANNE
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 MARGARET CT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538-5019
Mailing Address - Country:US
Mailing Address - Phone:630-859-2159
Mailing Address - Fax:
Practice Address - Street 1:2853 E NEW YORK ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-9059
Practice Address - Country:US
Practice Address - Phone:630-851-0710
Practice Address - Fax:630-851-0431
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice