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General NPI Number Information
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NPI Number | 1831324052
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Entity Type | Organization
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Legal Business Name | GLADYS J. WHITTEN, DMD, PA
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Dates
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Enumeration Date | 05/18/2009
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Last Update Date | 10/01/2014
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Provider Practice Location Address
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Address Line | 5730 66TH ST SUITE 2
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City | LUBBOCK
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State | TX
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Zip | 79424-1224
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Country | US
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Telephone | 806-535-0238
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Fax | 806-794-0025
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Provider Business Mailing Address
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Address Line | PO BOX 16209
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City | LUBBOCK
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State | TX
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Zip | 79490-6209
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Country | US
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Telephone | 806-535-0238
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Fax | 806-794-0025
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Authorized Official
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Title or Position | ORAL & MAXILLOFACIAL SURGEON/ PRES.
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Name | DR. GLADYS JOHNSON WHITTEN
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Credential | D.M.D.
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Telephone | 806-535-0238
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 11953
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License Number State | TX
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