Provider Demographics
NPI:1164555967
Name:WHITE, KATRINA CAROL (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:CAROL
Last Name:WHITE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4330 HIGHWAY 78 E
Mailing Address - Street 2:SUITE 121
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-8905
Mailing Address - Country:US
Mailing Address - Phone:205-384-9104
Mailing Address - Fax:205-384-9102
Practice Address - Street 1:4330 HIGHWAY 78 E
Practice Address - Street 2:SUITE 121
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-8905
Practice Address - Country:US
Practice Address - Phone:205-384-9104
Practice Address - Fax:205-384-9102
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL49671223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51506630OtherBLUE CROSS
05006Medicare UPIN