Shaun Michael Whitney, D.D.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

D4420PE Issued in ID

Practice address

1322 W Kathleen Ave Ste 2
Coeur D Alene, ID 83815-7365

Phone

(208) 664-7300

NPI assigned

Aug 11, 2010

Last updated

Oct 15, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Whitney & Dale PLLC

  • Periodontics
  • Spokane Valley, WA
  • NPI 1356098107

  Endodontics

  NPD Authorized official
• Lake City Dental Specialties, PC

  • Periodontics
  • Coeur d'Alene, ID
  • NPI 1356693915

  Endodontics

  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1281484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350259200000",
    "number": "1275848582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1322 W KATHLEEN AVE STE 2",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838157365",
            "telephone_number": "208-664-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1322 W KATHLEEN AVE STE 2",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838157365",
            "telephone_number": "208-664-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITNEY",
        "first_name": "SHAUN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-11",
        "last_updated": "2012-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "ID",
            "license": "D4420EN",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "ID",
            "license": "D4420PE",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Anthony Whiting, PT
• Michael David Whiting, M.D.
• Samantha C Whiting, OTR
• Theresa Whitlock-Wild
• Gloria Louise Whitman, LMP
• Kathleen Widmyer, RPH
• Lynn Wierdsma, PSY.D.
• Richard Lee Wiesemann II
• Craig W Wiesenhutter, MD
• Olivia Wika, PA

• Periodontics in Coeur d'Alene, ID
• Providers in Coeur d'Alene, ID by specialty
• Periodontics in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.