Provider Demographics
NPI:1063507671
Name:WHITE, ERIKA LYNN (DMD)
Entity Type:Individual
Prefix:MRS
First Name:ERIKA
Middle Name:LYNN
Last Name:WHITE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 E MUHAMMAD ALI BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1643
Mailing Address - Country:US
Mailing Address - Phone:502-569-1667
Mailing Address - Fax:502-569-6201
Practice Address - Street 1:712 E MUHAMMAD ALI BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1643
Practice Address - Country:US
Practice Address - Phone:502-569-1667
Practice Address - Fax:502-569-6201
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY83001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60004603Medicaid