Provider Demographics
NPI:1720230527
Name:WHITAKER, GEORGE C (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:C
Last Name:WHITAKER
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8815 CENTRE PARK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2282
Mailing Address - Country:US
Mailing Address - Phone:410-730-3311
Mailing Address - Fax:
Practice Address - Street 1:8815 CENTRE PARK DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2282
Practice Address - Country:US
Practice Address - Phone:410-730-3311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD65131223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics