Provider Demographics
NPI:1699939736
Name:WHITESIDES, JOSEPH M (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:M
Last Name:WHITESIDES
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 EL CERITO CT
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-6430
Mailing Address - Country:US
Mailing Address - Phone:813-706-5425
Mailing Address - Fax:
Practice Address - Street 1:840 CENTRAL PKWY E
Practice Address - Street 2:SUITE 100
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-5551
Practice Address - Country:US
Practice Address - Phone:972-578-7800
Practice Address - Fax:469-361-4700
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN188141223X0400X
TX241211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL454958919OtherOFFICE ENI