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General NPI Number Information
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NPI Number | 1093954869
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Entity Type | Individual
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Provider Name | WILLIAM ELVIN WHITLEY D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 02/18/2009
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Last Update Date | 05/21/2009
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Provider Practice Location Address
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Address Line | 1152 N BUCKNER BLVD STE H100A
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City | DALLAS
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State | TX
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Zip | 75218-3483
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Country | US
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Telephone | 214-320-9679
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Fax | 214-320-9878
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Provider Business Mailing Address
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Address Line | 5847 CLENDENIN AVE
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City | DALLAS
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State | TX
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Zip | 75228-6038
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Country | US
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Telephone | 214-328-9349
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Fax | 214-319-9349
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 18712
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License Number State | TX
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