MEDICARE: WILLIAM C. WHITTLE DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	12254	TX

General Provider Information

NPI Number	:	1306201470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM C. WHITTLE DDS PC

Provider Business Mailing Address
First Line	:	310 MERCEDES ST
Second Line	:
City	:	BENBROOK
State	:	TX
Zip	:	76126-2593
Country	:	US
Telephone Number	:	817-249-5522
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 MERCEDES ST
Second Line	:
City	:	BENBROOK
State	:	TX
Zip	:	76126-2593
Country	:	US
Telephone Number	:	817-249-5522
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	WILLIAM CHARLES WHITTLE
Credential	:
Telephone Number	:	817-249-5522

Provider Enumeration Date	:	12/16/2015
Last Update Date	:	12/16/2015

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