Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DS0000004085 | TN |
NPI | 1407830300 |
---|---|
Provider Name | Dr. William T. Whitworth |
First Address | Cookeville, TN 38501-3779 |
Second Address | Cookeville, TN 38501-3401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2005 |
Last Update Date | 08/07/2007 |