Provider Demographics
NPI:1003460080
Name:WHITWORTH, KATIE WESNESKI (DDS)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:WESNESKI
Last Name:WHITWORTH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6595 RANCH ROAD 385
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:TX
Mailing Address - Zip Code:76854-5600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1211 S BRIDGE ST
Practice Address - Street 2:
Practice Address - City:BRADY
Practice Address - State:TX
Practice Address - Zip Code:76825-6229
Practice Address - Country:US
Practice Address - Phone:325-597-0464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX355151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice