MEDICARE: JOE BILL WHITLEY,DDS,INC.

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	1223G0001X	General Practice Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447417043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOE BILL WHITLEY,DDS,INC.

Provider Business Mailing Address
First Line	:	2206 E COMMERCE ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78203-1902
Country	:	US
Telephone Number	:	210-224-4026
Fax Number	:	210-224-0075

Provider Business Practice Location Address
First Line	:	2206 E COMMERCE ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78203-1902
Country	:	US
Telephone Number	:	210-224-4026
Fax Number	:	210-224-0075

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. PAMELA WHITLEY-CASTO
Credential	:
Telephone Number	:	361-991-7207

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	05/21/2008

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