Provider Demographics
NPI:1730277567
Name:WHITTAKER, DAVID ALLEN (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALLEN
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 1:173 ASHLEY AVE
Mailing Address - Street 2:BSB346
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-0001
Mailing Address - Country:US
Mailing Address - Phone:843-792-3444
Mailing Address - Fax:
Practice Address - Street 1:173 ASHLEY AVE
Practice Address - Street 2:BSB346
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-0001
Practice Address - Country:US
Practice Address - Phone:843-792-3444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2960122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist