Healthcare Provider Details

I. General information

NPI: 1063852580
Provider Name (Legal Business Name): WHITNEY G MCBRAYER D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 BROADWAY STE 5
LUBBOCK TX
79401-3209
US

IV. Provider business mailing address

1313 BROADWAY STE 5
LUBBOCK TX
79401-3209
US

V. Phone/Fax

Practice location:
  • Phone: 806-765-2605
  • Fax: 806-687-5957
Mailing address:
  • Phone: 806-765-2605
  • Fax: 806-687-5957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number29805
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: