Provider Demographics
NPI:1013399906
Name:WHITE, FADI E
Entity Type:Individual
Prefix:
First Name:FADI
Middle Name:E
Last Name:WHITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E GLADE RD APT 3209
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-7310
Mailing Address - Country:US
Mailing Address - Phone:586-447-6833
Mailing Address - Fax:
Practice Address - Street 1:101 AUSTIN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-4661
Practice Address - Country:US
Practice Address - Phone:469-552-9944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-26
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021618122300000X
MI53150722021223G0001X
TX33651122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice