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General NPI Number Information
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NPI Number | 1942334727
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Entity Type | Organization
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Legal Business Name | EB WHILLOCK DDS, LTD.
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 804 WEST BLVD
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City | RAPID CITY
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State | SD
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Zip | 57701-3577
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Country | US
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Telephone | 605-348-2040
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Fax | 605-348-6712
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Provider Business Mailing Address
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Address Line | 804 WEST BLVD
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City | RAPID CITY
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State | SD
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Zip | 57701-3577
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Country | US
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Telephone | 605-348-2040
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Fax | 605-348-6712
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Authorized Official
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Title or Position | PERIODONTIST
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Name | DR. EDWARD BOYD WHILLOCK
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Credential | DDS
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Telephone | 605-348-2040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | M-347
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License Number State | SD
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