MEDICARE: DR. WILLIAM ELVIN WHITLEY D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	18712	TX

General Provider Information

NPI Number	:	1093954869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM ELVIN WHITLEY D.D.S.

Provider Business Mailing Address
First Line	:	5847 CLENDENIN AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-6038
Country	:	US
Telephone Number	:	214-328-9349
Fax Number	:	214-319-9349

Provider Business Practice Location Address
First Line	:	1152 N BUCKNER BLVD STE H100A
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75218-3483
Country	:	US
Telephone Number	:	214-320-9679
Fax Number	:	214-320-9878

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2009
Last Update Date	:	05/21/2009

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Directions to “ DR. WILLIAM ELVIN WHITLEY D.D.S.” Practice Location

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