Provider Demographics
NPI:1841211604
Name:WHITESELL, JAMES B (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:B
Last Name:WHITESELL
Suffix:
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 1:315 CREEKVIEW TER
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4697
Mailing Address - Country:US
Mailing Address - Phone:770-667-6507
Mailing Address - Fax:
Practice Address - Street 1:22 RAMSEY ST STE A
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-4445
Practice Address - Country:US
Practice Address - Phone:770-993-9521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0096051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice