Provider Demographics
NPI:1891902565
Name:JOHNWHITMAN,DDS/WAYNENAQUIN,DDS/APDC
Entity Type:Organization
Organization Name:JOHNWHITMAN,DDS/WAYNENAQUIN,DDS/APDC
Other - Org Name:FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:WHITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:985-876-3532
Mailing Address - Street 1:9283 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70363-3787
Mailing Address - Country:US
Mailing Address - Phone:985-876-3532
Mailing Address - Fax:985-876-3533
Practice Address - Street 1:9283 PARK AVENUE
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70363-3787
Practice Address - Country:US
Practice Address - Phone:985-876-3532
Practice Address - Fax:985-876-3533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA27761223G0001X
LA25981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty