MEDICARE: JOE BILL WHITLEY DDS INC

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	122300000X	Dentist	12325	TX
2	122300000X	Dentist	6593	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982863874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOE BILL WHITLEY DDS INC

Provider Business Mailing Address
First Line	:	2206 EAST COMMERCE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78203
Country	:	US
Telephone Number	:	210-224-4026
Fax Number	:	210-224-0075

Provider Business Practice Location Address
First Line	:	2206 EAST COMMERCE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78203
Country	:	US
Telephone Number	:	210-224-4026
Fax Number	:	210-224-0075

Authorized Official
Title or Position	:	DENTIST OWNER
Name	:	DR. JOE BILL WHITLEY
Credential	:	DDS
Telephone Number	:	210-224-4026

Provider Enumeration Date	:	06/05/2008
Last Update Date	:	06/05/2008

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