Provider Demographics
NPI:1851343149
Name:WITHERINGTON, BOBBY JOE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:JOE
Last Name:WITHERINGTON
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 1:303 W LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:AR
Mailing Address - Zip Code:71646-2907
Mailing Address - Country:US
Mailing Address - Phone:870-853-2548
Mailing Address - Fax:870-853-8995
Practice Address - Street 1:303 W LINCOLN ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:AR
Practice Address - Zip Code:71646-2907
Practice Address - Country:US
Practice Address - Phone:870-853-2548
Practice Address - Fax:870-853-8995
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR22381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR58933OtherBCBS
AR783918OtherUNITED CONCORDIA