Provider Demographics
NPI:1073784575
Name:WHITE, JOHNATHAN R (DDS)
Entity Type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:R
Last Name:WHITE
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 1:8084 W SAHARA AVE STE G
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1977
Mailing Address - Country:US
Mailing Address - Phone:702-823-3000
Mailing Address - Fax:702-685-8254
Practice Address - Street 1:8084 W SAHARA AVE STE G
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1977
Practice Address - Country:US
Practice Address - Phone:702-823-3000
Practice Address - Fax:702-685-8254
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV55561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice