Provider Demographics
NPI:1164574992
Name:WHITE, MELANIE E (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:E
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 1:39 W CHURCH ST
Mailing Address - Street 2:P.O. BOX 175
Mailing Address - City:EVANSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53536-1329
Mailing Address - Country:US
Mailing Address - Phone:608-882-4860
Mailing Address - Fax:608-882-4862
Practice Address - Street 1:39 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53536-1329
Practice Address - Country:US
Practice Address - Phone:608-882-4860
Practice Address - Fax:608-882-4862
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5601-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice