Provider Demographics
NPI:1013031244
Name:WHITE, TOMMY BERNARD (DMD)
Entity Type:Individual
Prefix:
First Name:TOMMY
Middle Name:BERNARD
Last Name:WHITE
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:P.O. BOX 555191
Mailing Address - Street 2:NAVAL HOSPITAL CAMP PENDLETON, DENTAL DEPARTMENT
Mailing Address - City:CAMP PENDLETON
Mailing Address - State:CA
Mailing Address - Zip Code:92055
Mailing Address - Country:US
Mailing Address - Phone:760-725-1200
Mailing Address - Fax:760-725-1539
Practice Address - Street 1:NAVAL HOSPITAL CAMP PENDLETON
Practice Address - Street 2:DENTAL DEPARTMENT
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055
Practice Address - Country:US
Practice Address - Phone:760-725-1200
Practice Address - Fax:760-725-1539
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021317L1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics