MEDICARE: DR. JAMES HENDERSON SMITH WHITNEY DDS

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	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	0401005040	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	005337	OTHER		ANTHEM
2	380876	OTHER		ANTHEM

General Provider Information

NPI Number	:	1417010430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES HENDERSON SMITH WHITNEY DDS

Provider Business Mailing Address
First Line	:	9626 S CONGRESS ST
Second Line	:
City	:	NEW MARKET
State	:	VA
Zip	:	22844-9450
Country	:	US
Telephone Number	:	540-740-8937
Fax Number	:	540-740-9227

Provider Business Practice Location Address
First Line	:	9626 S CONGRESS ST
Second Line	:
City	:	NEW MARKET
State	:	VA
Zip	:	22844-9450
Country	:	US
Telephone Number	:	540-740-8937
Fax Number	:	540-740-9227

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	08/31/2020

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