Provider Demographics
NPI:1538171830
Name:WHATELEY, BARON VICTOR (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:BARON
Middle Name:VICTOR
Last Name:WHATELEY
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-1965
Mailing Address - Country:US
Mailing Address - Phone:517-278-7900
Mailing Address - Fax:517-278-7953
Practice Address - Street 1:152 DIVISION ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-1965
Practice Address - Country:US
Practice Address - Phone:517-278-7900
Practice Address - Fax:517-278-7953
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010111551223X0400X
IN120079601223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000204351OtherINDIANA BCBS PROVIDOR #
IN100314820Medicaid
INT83645Medicare UPIN