Provider Demographics
NPI:1447417043
Name:JOE BILL WHITLEY,DDS,INC.
Entity Type:Organization
Organization Name:JOE BILL WHITLEY,DDS,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITLEY-CASTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-991-7207
Mailing Address - Street 1:2206 E COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78203-1902
Mailing Address - Country:US
Mailing Address - Phone:210-224-4026
Mailing Address - Fax:210-224-0075
Practice Address - Street 1:2206 E COMMERCE ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78203-1902
Practice Address - Country:US
Practice Address - Phone:210-224-4026
Practice Address - Fax:210-224-0075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1881725059Medicaid
TX1447381710Medicaid
TX1518085026Medicaid