Provider Demographics
NPI:1093702847
Name:WHITLEY, JAMES ARTHUR JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ARTHUR
Last Name:WHITLEY
Suffix:JR
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 1:510 GLENWOOD AVE
Mailing Address - Street 2:UNIT 407
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-1239
Mailing Address - Country:US
Mailing Address - Phone:919-833-9213
Mailing Address - Fax:
Practice Address - Street 1:309 W MILLBROOK RD
Practice Address - Street 2:SUITE 181
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4385
Practice Address - Country:US
Practice Address - Phone:919-789-0400
Practice Address - Fax:919-789-0440
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC54301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC99245OtherBCBS NC
NC7999245Medicaid