Provider Demographics
NPI:1174638035
Name:WHITE, GARY (DDS)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
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 1:689 VALLEY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:NJ
Mailing Address - Zip Code:07933-1906
Mailing Address - Country:US
Mailing Address - Phone:908-647-1588
Mailing Address - Fax:908-647-3067
Practice Address - Street 1:1390 VALLEY ROAD
Practice Address - Street 2:
Practice Address - City:STIRLING
Practice Address - State:NJ
Practice Address - Zip Code:07980
Practice Address - Country:US
Practice Address - Phone:908-647-1588
Practice Address - Fax:908-647-3067
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ20112122300000X
NY047144122300000X
NJ22DI02011200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist