Provider Demographics
NPI:1487941449
Name:WHATLEY, JUSTIN WADE (DMD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:WADE
Last Name:WHATLEY
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 1:301 DOTHAN RD
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36310-2901
Mailing Address - Country:US
Mailing Address - Phone:334-585-5400
Mailing Address - Fax:334-585-6800
Practice Address - Street 1:301 DOTHAN RD
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36310-2901
Practice Address - Country:US
Practice Address - Phone:334-585-5400
Practice Address - Fax:334-585-6800
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL58361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice