Provider Demographics
NPI:1740917632
Name:WILHOITE FAMILY DENTAL LLC
Entity type:Organization
Organization Name:WILHOITE FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LELAND
Authorized Official - Middle Name:
Authorized Official - Last Name:WILHOITE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-808-1393
Mailing Address - Street 1:3410 W PURDUE AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-5267
Mailing Address - Country:US
Mailing Address - Phone:765-747-9545
Mailing Address - Fax:765-747-0727
Practice Address - Street 1:3410 W PURDUE AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-5267
Practice Address - Country:US
Practice Address - Phone:765-747-9545
Practice Address - Fax:765-747-0727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1063146397OtherDENTIST
IN1952381840OtherDENTIST