Provider Demographics
NPI:1912342627
Name:WHITAKER, ROSEMARIE LIAO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROSEMARIE
Middle Name:LIAO
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16661 VENTURA BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1927
Mailing Address - Country:US
Mailing Address - Phone:818-651-7307
Mailing Address - Fax:
Practice Address - Street 1:16661 VENTURA BLVD STE 600
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1927
Practice Address - Country:US
Practice Address - Phone:818-651-7307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA641361223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program