Samuel Edward Whisenant Jr., L.D. D.P.D.

Primary specialty

DenturistTaxonomy code 122400000X

License

DN00000381 Issued in WA

Practice address

25052 104TH Ave SE
Suite G
Kent, WA 98030-6853

Phone

(253) 813-8000

Fax

(253) 813-8007

NPI assigned

Apr 18, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679799449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25052 104TH AVE SE",
            "address_2": "SUITE G",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980306853",
            "telephone_number": "253-813-8000",
            "fax_number": "253-813-8007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25052 104TH AVE SE",
            "address_2": "SUITE G",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980306853",
            "telephone_number": "253-813-8000",
            "fax_number": "253-813-8007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHISENANT",
        "first_name": "SAMUEL",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "L.D. D.P.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122400000X",
            "taxonomy_group": "",
            "desc": "Denturist",
            "state": "WA",
            "license": "DN00000381",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER",
            "identifier": "5047857",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brandie Weston, CNA
• Kelly M Weston, OI
• Bridget A. Whalen, OT
• Vanessa Maureen Whattam, BA MS
• Rachel Wheeler, LMHCA
• Roger L White PS, DC
• Areatha White, LMFT
• Christina White, SUDPT, RAAC
• Jonetta C White
• Patrick John White, LMHC

• Denturist in Kent, WA
• Providers in Kent, WA by specialty
• Denturist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.