Basic Information
| Provider Information | |||||||||
| NPI: | 1952533838 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHELTON | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 310 BLENNY LN | ||||||||
| Address2: | |||||||||
| City: | CHESTER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216199500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8583820874 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 503 MUIR ST | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216131871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102289381 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2009 | ||||||||
| LastUpdateDate: | 04/04/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 14489 | MD | Y | Dental Providers | Dentist | 122300000X | 48491 | CA | N | Dental Providers | Dentist | 122300000X | DS026029L | PA | N | Dental Providers | Dentist | 122300000X | HAD 8 | FL | N | Dental Providers | Dentist |
No ID Information.