Provider Demographics
NPI:1093769168
Name:WITHEROW, DONALD SHANE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:SHANE
Last Name:WITHEROW
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2059 LOMBARDY AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-1362
Mailing Address - Country:US
Mailing Address - Phone:615-347-4849
Mailing Address - Fax:
Practice Address - Street 1:1323 CLEARVIEW DR
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3424
Practice Address - Country:US
Practice Address - Phone:615-754-2027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN75401223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics