Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 6663 | NV |
Y | 1223X0400X | Orthodontists | 10924 | NC |
NPI | 1013390228 |
---|---|
Provider Name | Dr. Adam Brock Whiteley |
First Address | Boone, NC 28607-4934 |
Second Address | Boone, NC 28607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2015 |
Last Update Date | 16/08/2018 |