Provider Demographics
NPI:1023031804
Name:WHITLEY, DONALD ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ROBERT
Last Name:WHITLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2306 DR M L KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-4449
Mailing Address - Country:US
Mailing Address - Phone:252-636-3366
Mailing Address - Fax:
Practice Address - Street 1:2306 DR M L KING JR BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-4449
Practice Address - Country:US
Practice Address - Phone:252-636-3366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC49671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice