Provider Demographics
NPI:1134135254
Name:WHITEHURST, JAMES ALTON (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALTON
Last Name:WHITEHURST
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 1:515 BLAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4571
Mailing Address - Country:US
Mailing Address - Phone:919-782-3226
Mailing Address - Fax:
Practice Address - Street 1:202 W MILLBROOK RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4500
Practice Address - Country:US
Practice Address - Phone:919-847-8074
Practice Address - Fax:919-847-8173
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8999244Medicaid