Provider Demographics
NPI:1134307275
Name:WHITE, WENDY SUE (DDS)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:SUE
Last Name:WHITE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:SUE
Other - Last Name:WIDMAYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:BEAVER ISLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49782-0218
Mailing Address - Country:US
Mailing Address - Phone:231-448-2100
Mailing Address - Fax:231-448-2200
Practice Address - Street 1:37304 KINGS HIGHWAY
Practice Address - Street 2:
Practice Address - City:BEAVER ISLAND
Practice Address - State:MI
Practice Address - Zip Code:49782-0218
Practice Address - Country:US
Practice Address - Phone:231-448-2100
Practice Address - Fax:231-448-2200
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901016826122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist