Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DS0000002658 | TN |
NPI | 1043320856 |
---|---|
Provider Name | Dr. Fred Chatles Whitmire JR. |
First Address | Chattanooga, TN 37403-1121 |
Second Address | Chattanooga, TN 37403-1121 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |