Provider Demographics
NPI:1215093885
Name:WHITAKER, RALPH MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:MICHAEL
Last Name:WHITAKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2203 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-2026
Mailing Address - Country:US
Mailing Address - Phone:740-454-8148
Mailing Address - Fax:740-454-8413
Practice Address - Street 1:2203 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-2026
Practice Address - Country:US
Practice Address - Phone:740-454-8148
Practice Address - Fax:740-454-8413
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH150031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0294999Medicaid