Provider Demographics
NPI:1114142775
Name:WHITMORE, LYLE MANNING (DDS)
Entity Type:Individual
Prefix:DR
First Name:LYLE
Middle Name:MANNING
Last Name:WHITMORE
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 1:6800 POPLAR AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38138
Mailing Address - Country:US
Mailing Address - Phone:901-756-0005
Mailing Address - Fax:901-756-7334
Practice Address - Street 1:6800 POPLAR AVE
Practice Address - Street 2:STE 105
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138
Practice Address - Country:US
Practice Address - Phone:901-756-0005
Practice Address - Fax:901-756-7334
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0000002219122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist