Provider Demographics
NPI:1982895264
Name:WHITLEY, GARRY LEE (DMD)
Entity Type:Individual
Prefix:
First Name:GARRY
Middle Name:LEE
Last Name:WHITLEY
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 1:126 SUMMIT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-8409
Mailing Address - Country:US
Mailing Address - Phone:912-355-9094
Mailing Address - Fax:
Practice Address - Street 1:126 SUMMIT RIDGE DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-8409
Practice Address - Country:US
Practice Address - Phone:912-355-9094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0II292122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist