Provider Demographics
NPI:1184777161
Name:WHATLEY, PEGGY H (DDS)
Entity type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:H
Last Name:WHATLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 ROLLING MIST CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-5784
Mailing Address - Country:US
Mailing Address - Phone:770-442-6754
Mailing Address - Fax:
Practice Address - Street 1:3850 HOLCOMB BRIDGE RD
Practice Address - Street 2:SUITE 230
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-5223
Practice Address - Country:US
Practice Address - Phone:770-447-5311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN010865122300000X
LA4328122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist