Provider Demographics
NPI:1396948899
Name:WHITTAKER, DANIEL ROBERT (DMD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ROBERT
Last Name:WHITTAKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 VAN GUNDY DR
Mailing Address - Street 2:BLDG A
Mailing Address - City:BRYAN
Mailing Address - State:OH
Mailing Address - Zip Code:43506-1178
Mailing Address - Country:US
Mailing Address - Phone:419-636-4202
Mailing Address - Fax:419-363-6976
Practice Address - Street 1:201 VAN GUNDY DR
Practice Address - Street 2:BLDG A
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506-1178
Practice Address - Country:US
Practice Address - Phone:419-636-4202
Practice Address - Fax:419-363-6976
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH225401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice