Provider Demographics
NPI:1306201470
Name:WILLIAM C. WHITTLE DDS PC
Entity Type:Organization
Organization Name:WILLIAM C. WHITTLE DDS PC
Other - Org Name:WHITTLE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:WHITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-249-5522
Mailing Address - Street 1:310 MERCEDES ST
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126-2593
Mailing Address - Country:US
Mailing Address - Phone:817-249-5522
Mailing Address - Fax:
Practice Address - Street 1:310 MERCEDES ST
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76126-2593
Practice Address - Country:US
Practice Address - Phone:817-249-5522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty