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General NPI Number Information
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NPI Number | 1093895864
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Entity Type | Organization
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Legal Business Name | G. PHILIP WHITESIDE DMD, PSC
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 400 E MAIN ST
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City | GLASGOW
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State | KY
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Zip | 42141-2842
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Country | US
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Telephone | 270-651-6471
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Fax | 270-651-6454
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Provider Business Mailing Address
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Address Line | 400 E MAIN ST
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City | GLASGOW
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State | KY
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Zip | 42141-2842
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Country | US
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Telephone | 270-651-6471
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Fax | 270-651-6454
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. G. PHILIP WHITESIDE
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Credential | DMD
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Telephone | 270-651-6471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 075651
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License Number State | KY
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