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General NPI Number Information
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NPI Number | 1730328162
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Entity Type | Organization
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Legal Business Name | RANDALL L. WHITTEN, DDS, PA
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Dates
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Enumeration Date | 02/09/2009
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Last Update Date | 02/09/2009
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Provider Practice Location Address
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Address Line | 8700 CROWNHILL BLVD SUITE 210
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City | SAN ANTONIO
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State | TX
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Zip | 78209-1136
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Country | US
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Telephone | 210-824-9488
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Fax |
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Provider Business Mailing Address
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Address Line | 8700 CROWNHILL BLVD SUITE 210
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City | SAN ANTONIO
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State | TX
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Zip | 78209-1136
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Country | US
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Telephone | 210-824-9488
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RANDALL L WHITTEN
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Credential | D.D.S.
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Telephone | 210-824-9488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 11391
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License Number State | TX
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