Provider Demographics
NPI:1093019804
Name:WHITE, JAMIE RAE (DMD, MS, DHSC)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:RAE
Last Name:WHITE
Suffix:
Gender:F
Credentials:DMD, MS, DHSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1263
Mailing Address - Street 2:
Mailing Address - City:TUBAC
Mailing Address - State:AZ
Mailing Address - Zip Code:85646-1263
Mailing Address - Country:US
Mailing Address - Phone:520-390-1982
Mailing Address - Fax:
Practice Address - Street 1:2107 PASEO SAN LUIS
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-4563
Practice Address - Country:US
Practice Address - Phone:520-390-1982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-08
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0081011223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics