Provider Demographics
NPI:1871710830
Name:WHITNEY, RIEL EUGENE (DDS)
Entity type:Individual
Prefix:
First Name:RIEL
Middle Name:EUGENE
Last Name:WHITNEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2071 33RD AVE
Mailing Address - Street 2:STE A
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-3178
Mailing Address - Country:US
Mailing Address - Phone:402-564-1998
Mailing Address - Fax:
Practice Address - Street 1:2071 33RD AVE
Practice Address - Street 2:STE A
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-3178
Practice Address - Country:US
Practice Address - Phone:402-564-1998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE42851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470599630-00Medicaid