Provider Demographics
NPI:1063726040
Name:WHATLEY, DORIS JEANETTE (DMD, MSD)
Entity type:Individual
Prefix:DR
First Name:DORIS
Middle Name:JEANETTE
Last Name:WHATLEY
Suffix:
Gender:F
Credentials:DMD, MSD
Other - Prefix:DR
Other - First Name:JENNY
Other - Middle Name:J
Other - Last Name:WHATLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ENDODONTIST
Mailing Address - Street 1:126 BROOKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-7745
Mailing Address - Country:US
Mailing Address - Phone:256-724-3120
Mailing Address - Fax:
Practice Address - Street 1:126 BROOKRIDGE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-7745
Practice Address - Country:US
Practice Address - Phone:256-724-3120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL57091223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1063726040Medicaid