Provider Demographics
NPI:1730594409
Name:WHITFIELD, ATHENA CORINTHIA (DDS)
Entity type:Individual
Prefix:DR
First Name:ATHENA
Middle Name:CORINTHIA
Last Name:WHITFIELD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ATHENA
Other - Middle Name:CORINTHIA
Other - Last Name:GOAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5008 MIDWAY DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-1416
Mailing Address - Country:US
Mailing Address - Phone:254-773-1688
Mailing Address - Fax:254-773-6448
Practice Address - Street 1:5008 MIDWAY DR
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1416
Practice Address - Country:US
Practice Address - Phone:254-773-1688
Practice Address - Fax:254-773-6448
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-21
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX317891223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry