1730594409 NPI number — DR. ATHENA CORINTHIA WHITFIELD DDS

Table of content: DR. ATHENA CORINTHIA WHITFIELD DDS (NPI 1730594409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730594409 NPI number — DR. ATHENA CORINTHIA WHITFIELD DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITFIELD
Provider First Name:
ATHENA
Provider Middle Name:
CORINTHIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOAR
Provider Other First Name:
ATHENA
Provider Other Middle Name:
CORINTHIA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730594409
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5008 MIDWAY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEMPLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76502-1416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-773-1688
Provider Business Mailing Address Fax Number:
254-773-6448

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5008 MIDWAY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76502-1416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-773-1688
Provider Business Practice Location Address Fax Number:
254-773-6448
Provider Enumeration Date:
06/21/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  31789 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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