Brandon Walker Whitworth
Individual provider Active NPI Dentist · Easley, SC
NPI 1649522202 · NPPES record last updated Oct 8, 2012
Key facts
- NPI
- 1649522202
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 8149 (SC)
- Practice address
- 1040 S Pendleton St Ste C
Easley, SC 29642-1047 - Phone
- (864) 306-0800
- NPI assigned
- Oct 8, 2012
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8149 | SC | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 8149 | SC | Yes |
Addresses
Primary practice location
1040 S Pendleton St Ste C
Easley, SC 29642-1047
Mailing address
1040 S. Pendleton St Unit C
Easley, SC 29642
Phone (864) 306-0800
Other providers in Easley, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 8, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.