Provider Demographics
NPI:1760671663
Name:WITHEROW, LINDA LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:LEE
Last Name:WITHEROW
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6015 W NORDLING LOOP
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-8716
Mailing Address - Country:US
Mailing Address - Phone:352-795-5935
Mailing Address - Fax:352-795-4606
Practice Address - Street 1:6015 W NORDLING LOOP
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-8716
Practice Address - Country:US
Practice Address - Phone:352-795-5935
Practice Address - Fax:352-795-4606
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN104131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice