Healthcare Provider Details

I. General information

NPI: 1689697773
Provider Name (Legal Business Name): TERRY G WHATLEY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 08/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2321 JOHN HAWKINS PKWY SUITE 109
HOOVER AL
35244-3540
US

IV. Provider business mailing address

2321 JOHN HAWKINS PKWY SUITE 113
HOOVER AL
35244-3540
US

V. Phone/Fax

Practice location:
  • Phone: 205-987-1173
  • Fax: 205-987-5034
Mailing address:
  • Phone: 205-987-1173
  • Fax: 205-987-5034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number1315
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2982
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: