Provider Demographics
NPI:1093895864
Name:G. PHILIP WHITESIDE DMD, PSC
Entity Type:Organization
Organization Name:G. PHILIP WHITESIDE DMD, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:G.
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:WHITESIDE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-651-6471
Mailing Address - Street 1:400 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-2842
Mailing Address - Country:US
Mailing Address - Phone:270-651-6471
Mailing Address - Fax:270-651-6454
Practice Address - Street 1:400 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-2842
Practice Address - Country:US
Practice Address - Phone:270-651-6471
Practice Address - Fax:270-651-6454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0756511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty