Provider Demographics
NPI:1164882239
Name:WHITT, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:WHITT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 S US HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-5237
Mailing Address - Country:US
Mailing Address - Phone:352-751-1178
Mailing Address - Fax:352-753-0247
Practice Address - Street 1:1060 S US HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-5237
Practice Address - Country:US
Practice Address - Phone:352-751-1178
Practice Address - Fax:352-753-0247
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8305122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist