Provider Demographics
NPI:1518676618
Name:THOMAS L WHITAKER DMD PC
Entity Type:Organization
Organization Name:THOMAS L WHITAKER DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-289-0183
Mailing Address - Street 1:105 S WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:DEMOPOLIS
Mailing Address - State:AL
Mailing Address - Zip Code:36732-4335
Mailing Address - Country:US
Mailing Address - Phone:334-289-0183
Mailing Address - Fax:334-289-0152
Practice Address - Street 1:105 S WALNUT AVE
Practice Address - Street 2:
Practice Address - City:DEMOPOLIS
Practice Address - State:AL
Practice Address - Zip Code:36732-4335
Practice Address - Country:US
Practice Address - Phone:334-289-0183
Practice Address - Fax:334-289-0152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental