Organization
GLADYS J. WHITTEN, DMD, PA
Active
Other names
Caprock Oral & Maxillofacial Surgery, P.A.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLADYS JOHNSON WHITTEN D.M.D. (ORAL & MAXILLOFACIAL SURGEON/ PRES.)
(806) 535-0238
Entity
Organization
Contact information
Practice address
5730 66TH ST, SUITE 2, LUBBOCK, TX 79424-1224
(806) 535-0238
(806) 794-0025
Mailing address
PO BOX 16209, LUBBOCK, TX 79490-6209
(806) 535-0238
(806) 794-0025
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
11953
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
090259503
—
TX
Enumeration date
05/18/2009
Last updated
10/01/2014
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