Provider Demographics
NPI:1285729269
Name:WHYTOSEK, JOHN (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:WHYTOSEK
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 1:29 MORRIS AVE
Mailing Address - Street 2:BRYN MAWR CENTRAL
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3335
Mailing Address - Country:US
Mailing Address - Phone:610-527-6061
Mailing Address - Fax:610-527-5857
Practice Address - Street 1:29 MORRIS AVE
Practice Address - Street 2:BRYN MAWR CENTRAL
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3335
Practice Address - Country:US
Practice Address - Phone:610-527-6061
Practice Address - Fax:610-527-5857
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-030593-L1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics