Provider Demographics
NPI:1164684668
Name:WHITEHURST, LEON J (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:J
Last Name:WHITEHURST
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 PONCE DE LEON BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BELLEAIR
Mailing Address - State:FL
Mailing Address - Zip Code:33756-1073
Mailing Address - Country:US
Mailing Address - Phone:727-586-3582
Mailing Address - Fax:
Practice Address - Street 1:1016 PONCE DE LEON BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:BELLEAIR
Practice Address - State:FL
Practice Address - Zip Code:33756-1073
Practice Address - Country:US
Practice Address - Phone:727-586-3582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00073471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice