Provider Demographics
NPI:1225322217
Name:WHITAKER, KATHERINE LANWAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:LANWAY
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-1455
Mailing Address - Country:US
Mailing Address - Phone:606-523-1415
Mailing Address - Fax:606-528-9804
Practice Address - Street 1:213 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-1455
Practice Address - Country:US
Practice Address - Phone:606-523-1415
Practice Address - Fax:606-528-9804
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY90211223G0001X, 122300000X
TN9515122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice