Provider Demographics
NPI:1851312847
Name:STUART H. WHIDDON, D.D.S., P.A.
Entity Type:Organization
Organization Name:STUART H. WHIDDON, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:HALL
Authorized Official - Last Name:WHIDDON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-476-1109
Mailing Address - Street 1:1040 RANDOLPH ST
Mailing Address - Street 2:SUITE 19
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-6383
Mailing Address - Country:US
Mailing Address - Phone:336-476-1109
Mailing Address - Fax:336-476-1101
Practice Address - Street 1:1040 RANDOLPH ST
Practice Address - Street 2:SUITE 19
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-6383
Practice Address - Country:US
Practice Address - Phone:336-476-1109
Practice Address - Fax:336-476-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4824261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899203Medicaid