Provider Demographics
NPI:1720096126
Name:WHITSON, DUDLEY MARTIN (DMD)
Entity type:Individual
Prefix:DR
First Name:DUDLEY
Middle Name:MARTIN
Last Name:WHITSON
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:PO BOX 577
Mailing Address - Street 2:
Mailing Address - City:DANDRIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37725-0577
Mailing Address - Country:US
Mailing Address - Phone:865-397-2956
Mailing Address - Fax:865-397-5589
Practice Address - Street 1:1047 A SOUTH HWY 92
Practice Address - Street 2:
Practice Address - City:DANDRIDGE
Practice Address - State:TN
Practice Address - Zip Code:37725
Practice Address - Country:US
Practice Address - Phone:865-397-2956
Practice Address - Fax:865-397-5589
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS4714122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist