Provider Demographics
NPI:1326120544
Name:WHITTAKER, NEIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:
Last Name:WHITTAKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 RITCHIE HWY
Mailing Address - Street 2:S-30
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-4135
Mailing Address - Country:US
Mailing Address - Phone:410-384-9030
Mailing Address - Fax:
Practice Address - Street 1:780 RITCHIE HWY
Practice Address - Street 2:S-30
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-4135
Practice Address - Country:US
Practice Address - Phone:410-384-9030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12504122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist