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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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