Provider Demographics
NPI:1235230731
Name:WHITLEY, ROBERT DARRELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DARRELL
Last Name:WHITLEY
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 1:583 CRICKET LN
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-4838
Mailing Address - Country:US
Mailing Address - Phone:610-458-2409
Mailing Address - Fax:
Practice Address - Street 1:5279 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:GAP
Practice Address - State:PA
Practice Address - Zip Code:17527-9427
Practice Address - Country:US
Practice Address - Phone:717-442-9537
Practice Address - Fax:717-442-8311
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021989L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0026811000OtherKEYSTONE EAST
PA01684301OtherCAPITAL BLUE CROSS BLUE
PA01684301OtherKEYSTONE CENTRAL
PA048271OtherAMERIHEALTH
PA2199521OtherAETNA HEALTHCARE