Provider Demographics
NPI:1538334636
Name:WHITWELL DENTISTRY INC
Entity type:Organization
Organization Name:WHITWELL DENTISTRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WHITWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-842-1115
Mailing Address - Street 1:5103 N SHARTEL AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-6024
Mailing Address - Country:US
Mailing Address - Phone:405-842-1115
Mailing Address - Fax:405-842-2046
Practice Address - Street 1:5103 N SHARTEL AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-6024
Practice Address - Country:US
Practice Address - Phone:405-842-1115
Practice Address - Fax:405-842-2046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5502261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5502OtherOK DENTAL LICENSE