Provider Demographics
NPI:1144326745
Name:WHIPPLE, JOHN L JR (DDS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:WHIPPLE
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 1:1400 SOUTHWEST BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-2430
Mailing Address - Country:US
Mailing Address - Phone:573-634-4909
Mailing Address - Fax:573-634-9047
Practice Address - Street 1:1400 SOUTHWEST BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-2430
Practice Address - Country:US
Practice Address - Phone:573-634-4909
Practice Address - Fax:573-634-9047
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0123251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice