Provider Demographics
NPI:1952576597
Name:J FRANKLIN WHIPPS
Entity Type:Organization
Organization Name:J FRANKLIN WHIPPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:WHIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-532-1821
Mailing Address - Street 1:1020 JONAS STREET
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801
Mailing Address - Country:US
Mailing Address - Phone:618-532-1821
Mailing Address - Fax:618-532-1915
Practice Address - Street 1:1020 JONAS STREET
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801
Practice Address - Country:US
Practice Address - Phone:618-532-1821
Practice Address - Fax:618-532-1915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019013703DENTIST122300000X
IL021000787ORTHODONTIS1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1004783OtherDORAL
IL789671OtherUNITED CONCORDIA