Provider Demographics
NPI:1740493550
Name:J. MICHAEL WHITT DMD PA
Entity type:Organization
Organization Name:J. MICHAEL WHITT DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WHITT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-989-2020
Mailing Address - Street 1:1060 S HWY 27 441
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-0247
Mailing Address - Country:US
Mailing Address - Phone:352-751-1178
Mailing Address - Fax:352-753-0247
Practice Address - Street 1:1060 S 27 441
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159
Practice Address - Country:US
Practice Address - Phone:352-757-1178
Practice Address - Fax:352-753-0247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 8305122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty