Provider Demographics
NPI:1396759320
Name:WHITWORTH, JOHN C (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:WHITWORTH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 E IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5544
Mailing Address - Country:US
Mailing Address - Phone:714-672-9000
Mailing Address - Fax:714-672-9086
Practice Address - Street 1:503 E IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5544
Practice Address - Country:US
Practice Address - Phone:714-672-9000
Practice Address - Fax:714-672-9086
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA233981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice