Provider Demographics
NPI:1619074705
Name:WHELESS, JOHN RUFFIN III (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RUFFIN
Last Name:WHELESS
Suffix:III
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 1:1011 CORN TASSEL TRL
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-5605
Mailing Address - Country:US
Mailing Address - Phone:276-632-7808
Mailing Address - Fax:276-632-6456
Practice Address - Street 1:311 BROWN ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-3801
Practice Address - Country:US
Practice Address - Phone:276-632-3151
Practice Address - Fax:276-632-6456
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010043241223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics