Jack a. Whittaker D.D.S., Inc.

Primary specialty

DentistTaxonomy code 122300000X

License

30 012369 Issued in OH

Legal business name

JACK A. WHITTAKER D.D.S., INC.

Practice address

960 W Wooster St
Suite 201
Bowling Green, OH 43402-2644

Phone

(419) 352-3527

Fax

(419) 352-6122

NPI assigned

Apr 3, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jack Allen Whittaker, D.D.S.

Title

Pediatric Dentist

Phone

(419) 352-3527

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1207180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207180800000",
    "number": "1851564579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 W WOOSTER ST",
            "address_2": "SUITE 201",
            "city": "BOWLING GREEN",
            "state": "OH",
            "postal_code": "434022644",
            "telephone_number": "419-352-3527",
            "fax_number": "419-352-6122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "960 W WOOSTER ST",
            "address_2": "SUITE 201",
            "city": "BOWLING GREEN",
            "state": "OH",
            "postal_code": "434022644",
            "telephone_number": "419-352-3527",
            "fax_number": "419-352-6122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK A. WHITTAKER D.D.S., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-03",
        "last_updated": "2008-04-03",
        "status": "A",
        "authorized_official_last_name": "WHITTAKER",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "419-352-3527",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "OH",
            "license": "30 012369",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017332",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DORAL DENTAL SERVICES",
            "identifier": "7073",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARAMOUNT ADVANTAGE",
            "identifier": "01928",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Bowling Green, OH
• Providers in Bowling Green, OH by specialty
• Dentist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.