Anita Whalen, DDS

Individual provider Active NPI General Practice Dentistry · Warren, MN

NPI 1003092206 · NPPES record last updated Feb 19, 2009

Key facts

NPI
1003092206
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
D8197 (MN)
Practice address
508 North Minnesota Street
Warren, MN 56762-0093
Phone
(218) 281-3441
Fax
(218) 281-6966
NPI assigned
Jan 17, 2008
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
D8197MNMDGeneral Practice Dentistry

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D8197 MN Yes

Addresses

Primary practice location

508 North Minnesota Street
Warren, MN 56762-0093

Mailing address

620 Summit Avenue
Crookston, MN 56716-2799
Phone (218) 281-3441

Other identifiers

IdentifierTypeStateIssuer
531018100MedicaidMN

Other names

  • Mary Jean Whalen Other name

Other providers in Warren, MN

All providers in Warren, MN · General Practice Dentistry in Minnesota

Sources for this page

Verify at the official NPI Registry.