Healthcare Provider Details

I. General information

NPI: 1407830300
Provider Name (Legal Business Name): WILLIAM T. WHITWORTH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 S DIXIE AVE
COOKEVILLE TN
38501-3401
US

IV. Provider business mailing address

798 W OAK DR #E-3
COOKEVILLE TN
38501-3779
US

V. Phone/Fax

Practice location:
  • Phone: 931-528-2531
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDS0000004085
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: