Provider Demographics
NPI:1407830300
Name:WHITWORTH, WILLIAM T (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:T
Last Name:WHITWORTH
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 1:798 W OAK DR
Mailing Address - Street 2:#E-3
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-3779
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:121 S DIXIE AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-3401
Practice Address - Country:US
Practice Address - Phone:931-528-2531
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
TNDS00000040851223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health