Provider Demographics
NPI:1174668008
Name:WHITEHEAD, BILLY GENE JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:BILLY
Middle Name:GENE
Last Name:WHITEHEAD
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:707 DRUID RD E
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3951
Mailing Address - Country:US
Mailing Address - Phone:727-441-8963
Mailing Address - Fax:727-461-2208
Practice Address - Street 1:707 DRUID RD E
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3951
Practice Address - Country:US
Practice Address - Phone:727-441-8963
Practice Address - Fax:727-461-2208
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN106681223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry