Provider Demographics
NPI:1669788808
Name:WHTDMD,LLC
Entity type:Organization
Organization Name:WHTDMD,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:TROUT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:912-665-2792
Mailing Address - Street 1:10140 FORD AVE
Mailing Address - Street 2:SUITE G2
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-3992
Mailing Address - Country:US
Mailing Address - Phone:912-665-2792
Mailing Address - Fax:888-289-4301
Practice Address - Street 1:10140 FORD AVE
Practice Address - Street 2:SUITE G2
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3992
Practice Address - Country:US
Practice Address - Phone:912-665-2792
Practice Address - Fax:888-289-4301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-25
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10747122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty