Provider Demographics
NPI:1528104155
Name:WHITTLE, WILLIAM CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CHARLES
Last Name:WHITTLE
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 1:310 MERCEDES ST.
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126
Mailing Address - Country:US
Mailing Address - Phone:817-249-5522
Mailing Address - Fax:817-249-5538
Practice Address - Street 1:310 MERCEDES ST.
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76126
Practice Address - Country:US
Practice Address - Phone:817-249-5522
Practice Address - Fax:817-249-5538
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice