Provider Demographics
NPI:1093842296
Name:WHITE, DIANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
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 1:410 W CENTRAL AVE
Mailing Address - Street 2:SUITE #208
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-3014
Mailing Address - Country:US
Mailing Address - Phone:714-529-5999
Mailing Address - Fax:714-529-6070
Practice Address - Street 1:410 W CENTRAL AVE
Practice Address - Street 2:SUITE #208
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3014
Practice Address - Country:US
Practice Address - Phone:714-529-5999
Practice Address - Fax:714-529-6070
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA342561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice