Provider Demographics
NPI:1326202755
Name:LELAND C. WILHOITE,D.D.S.,P.C.
Entity Type:Organization
Organization Name:LELAND C. WILHOITE,D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LELAND
Authorized Official - Middle Name:CRAWFORD
Authorized Official - Last Name:WILHOITE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-289-6373
Mailing Address - Street 1:2623 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4634
Mailing Address - Country:US
Mailing Address - Phone:765-289-6373
Mailing Address - Fax:765-289-6375
Practice Address - Street 1:2623 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-4634
Practice Address - Country:US
Practice Address - Phone:765-289-6373
Practice Address - Fax:765-289-6375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120098971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200501540BMedicaid