Provider Demographics
NPI:1083970354
Name:WHITE, KATHRYN MCDANIEL (DMD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MCDANIEL
Last Name:WHITE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ELLIS
Other - Last Name:MCDANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 25604
Mailing Address - Street 2:2101 PELHAM RD.
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29616-0604
Mailing Address - Country:US
Mailing Address - Phone:864-288-5300
Mailing Address - Fax:864-288-9430
Practice Address - Street 1:2101 PELHAM RD.
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615
Practice Address - Country:US
Practice Address - Phone:864-288-5300
Practice Address - Fax:864-288-9430
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC82051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice