Provider Demographics
NPI:1114940897
Name:WHITE, PAUL R (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:WHITE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5237 HICKORY PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-2616
Mailing Address - Country:US
Mailing Address - Phone:804-747-7447
Mailing Address - Fax:804-747-7449
Practice Address - Street 1:5237 HICKORY PARK DRIVE
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-2616
Practice Address - Country:US
Practice Address - Phone:804-747-7447
Practice Address - Fax:804-747-7449
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010068701223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics