Provider Demographics
NPI:1174507065
Name:WHITWELL, BRYAN LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:LEE
Last Name:WHITWELL
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 1:5103 N SHARTEL AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-6024
Mailing Address - Country:US
Mailing Address - Phone:405-842-1115
Mailing Address - Fax:
Practice Address - Street 1:5103 N SHARTEL AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-6024
Practice Address - Country:US
Practice Address - Phone:405-842-1115
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK55021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice