Provider Demographics
NPI:1982863874
Name:JOE BILL WHITLEY DDS INC
Entity Type:Organization
Organization Name:JOE BILL WHITLEY DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:BILL
Authorized Official - Last Name:WHITLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-224-4026
Mailing Address - Street 1:2206 EAST COMMERCE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78203
Mailing Address - Country:US
Mailing Address - Phone:210-224-4026
Mailing Address - Fax:210-224-0075
Practice Address - Street 1:2206 EAST COMMERCE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78203
Practice Address - Country:US
Practice Address - Phone:210-224-4026
Practice Address - Fax:210-224-0075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6593122300000X
TX12325122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120877902Medicaid