Provider Demographics
NPI:1033382791
Name:WHITE, MAREA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAREA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 CENTRAL DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-5883
Mailing Address - Country:US
Mailing Address - Phone:817-283-0047
Mailing Address - Fax:817-283-0655
Practice Address - Street 1:2117 CENTRAL DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5883
Practice Address - Country:US
Practice Address - Phone:817-283-0047
Practice Address - Fax:817-283-0655
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX161051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice