Provider Demographics
NPI:1164094058
Name:WHITE, BROOKLYNN RENEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:BROOKLYNN
Middle Name:RENEE
Last Name:WHITE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 RYLEIGH LN APT A
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-9464
Mailing Address - Country:US
Mailing Address - Phone:618-830-0533
Mailing Address - Fax:
Practice Address - Street 1:105 OXFORD EXCHANGE BLVD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-3448
Practice Address - Country:US
Practice Address - Phone:256-676-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD-0006946-C11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty