Provider Demographics
NPI:1477619047
Name:WHITAKER, ANDREW MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:MICHAEL
Last Name:WHITAKER
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 1:501 DARBY CREEK RD STE 68
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2611
Mailing Address - Country:US
Mailing Address - Phone:859-263-0550
Mailing Address - Fax:740-454-8413
Practice Address - Street 1:501 DARBY CREEK RD STE 68
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2611
Practice Address - Country:US
Practice Address - Phone:859-263-0550
Practice Address - Fax:740-454-8413
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH217771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice