Provider Demographics
NPI:1548390958
Name:WHITBRED, BARBARA W
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:W
Last Name:WHITBRED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3874 ASCOT LN
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-6954
Mailing Address - Country:US
Mailing Address - Phone:239-489-2464
Mailing Address - Fax:
Practice Address - Street 1:15650 SAN CARLOS BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-2569
Practice Address - Country:US
Practice Address - Phone:239-489-1118
Practice Address - Fax:239-489-3627
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH4568124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist