Provider Demographics
NPI:1245282854
Name:WHITTINGTON, JOHN MONROE (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MONROE
Last Name:WHITTINGTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N MAIN ST
Mailing Address - Street 2:PO BOX 1189
Mailing Address - City:MARION
Mailing Address - State:SC
Mailing Address - Zip Code:29571-2011
Mailing Address - Country:US
Mailing Address - Phone:843-423-3481
Mailing Address - Fax:843-423-3859
Practice Address - Street 1:1300 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:SC
Practice Address - Zip Code:29571-2011
Practice Address - Country:US
Practice Address - Phone:843-423-3481
Practice Address - Fax:843-423-3859
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ19748Medicaid