Provider Demographics
NPI:1669551677
Name:WHISENANT, LARRY JOE (DMD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:JOE
Last Name:WHISENANT
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:POB 448
Mailing Address - Street 2:121 10TH ST NW
Mailing Address - City:VERNON
Mailing Address - State:AL
Mailing Address - Zip Code:35592
Mailing Address - Country:US
Mailing Address - Phone:205-695-7171
Mailing Address - Fax:205-695-0801
Practice Address - Street 1:121 10TH ST NW
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:AL
Practice Address - Zip Code:35592
Practice Address - Country:US
Practice Address - Phone:205-695-7171
Practice Address - Fax:205-695-0801
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL3713122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL008208040Medicaid
AL51097482OtherBCBS OF AL