Healthcare Provider Details

I. General information

NPI: 1386617751
Provider Name (Legal Business Name): STEVEN BRYAN WHITAKER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 UNION AVE
MEMPHIS TN
38103-3513
US

IV. Provider business mailing address

875 UNION AVE
MEMPHIS TN
38103-3513
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-4559
  • Fax:
Mailing address:
  • Phone: 901-448-4559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number2
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number18
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number12978
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: