Provider Demographics
NPI:1477767150
Name:ODIE A. WHITLOW, D.D.S.
Entity Type:Organization
Organization Name:ODIE A. WHITLOW, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ODIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WHITLOW
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-222-3310
Mailing Address - Street 1:7063 MESSER RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23231-5509
Mailing Address - Country:US
Mailing Address - Phone:804-222-3310
Mailing Address - Fax:804-222-6973
Practice Address - Street 1:7063 MESSER RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23231-5509
Practice Address - Country:US
Practice Address - Phone:804-222-3310
Practice Address - Fax:804-222-6973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010041811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1972580728OtherTYPE I NPI