Provider Demographics
NPI:1114471026
Name:WHITE, SHANTAL J (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHANTAL
Middle Name:J
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 1:1400 GRANBY ST UNIT 304
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-2666
Mailing Address - Country:US
Mailing Address - Phone:210-789-6291
Mailing Address - Fax:
Practice Address - Street 1:237 HANBURY RD E STE 30
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-6622
Practice Address - Country:US
Practice Address - Phone:757-547-2134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014172511223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry