Provider Demographics
NPI:1982851481
Name:WHITESIDE, WILLIAM COOK (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:COOK
Last Name:WHITESIDE
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 1:400 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-2842
Mailing Address - Country:US
Mailing Address - Phone:270-651-6471
Mailing Address - Fax:270-651-6454
Practice Address - Street 1:400 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-2842
Practice Address - Country:US
Practice Address - Phone:270-651-6471
Practice Address - Fax:270-651-6454
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8543122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist