Provider Demographics
NPI:1083177695
Name:WHITE, CONNIE LOU (DDS)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:LOU
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 1:650 EAST 25TH STREET
Mailing Address - Street 2:SCHOOL OF DENTISTRY
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-2784
Mailing Address - Country:US
Mailing Address - Phone:816-235-2135
Mailing Address - Fax:816-235-5472
Practice Address - Street 1:650 EAST 25TH STREET
Practice Address - Street 2:SCHOOL OF DENTISTRY
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2784
Practice Address - Country:US
Practice Address - Phone:816-235-2100
Practice Address - Fax:816-235-5472
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0136211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice