Provider Demographics
NPI:1386387082
Name:MATTESON, WHITNEY WILLARD (RDH)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:WILLARD
Last Name:MATTESON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3818 RAINFOREST CIR
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-2348
Mailing Address - Country:US
Mailing Address - Phone:678-724-6575
Mailing Address - Fax:
Practice Address - Street 1:950 W PEACHTREE ST NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3846
Practice Address - Country:US
Practice Address - Phone:404-381-8586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADH006370124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist