Individual
DR. KELVIN SCOTT WHITAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1215 13TH AVE SE, DECATUR, AL 35601-4306
(256) 353-1481
Mailing address
1215 13TH AVE SE, DECATUR, AL 35601-4306
(256) 353-1481
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
AL4965
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51514998 WHI
BLUE CROSS BLUE SHIELD
—
Enumeration date
10/06/2006
Last updated
07/09/2007
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