Provider Demographics
NPI:1083950042
Name:JOHN R WHITE DDS & CHRISTOPHER N SIACHOS
Entity Type:Organization
Organization Name:JOHN R WHITE DDS & CHRISTOPHER N SIACHOS
Other - Org Name:CLEVELAND STREET FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:864-271-4006
Mailing Address - Street 1:1352 CLEVELAND ST STE A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2437
Mailing Address - Country:US
Mailing Address - Phone:864-271-4006
Mailing Address - Fax:864-271-4370
Practice Address - Street 1:1352 CLEVELAND ST STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2437
Practice Address - Country:US
Practice Address - Phone:864-271-4006
Practice Address - Fax:864-271-4370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment