Organization
JACK A. WHITTAKER D.D.S., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK ALLEN WHITTAKER D.D.S. (PEDIATRIC DENTIST)
(419) 352-3527
Entity
Organization
Contact information
Practice address
960 W WOOSTER ST, SUITE 201, BOWLING GREEN, OH 43402-2644
(419) 352-3527
(419) 352-6122
Mailing address
960 W WOOSTER ST, SUITE 201, BOWLING GREEN, OH 43402-2644
(419) 352-3527
(419) 352-6122
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
30 012369
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017332
—
OH
01
—
01928
PARAMOUNT ADVANTAGE
OH
01
—
7073
DORAL DENTAL SERVICES
OH
Enumeration date
04/03/2008
Last updated
04/03/2008
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