Provider Demographics
NPI:1205037884
Name:WHITE, MECHELLE HOWARD (RDH)
Entity Type:Individual
Prefix:
First Name:MECHELLE
Middle Name:HOWARD
Last Name:WHITE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 RIVER VALLEY TRL
Mailing Address - Street 2:
Mailing Address - City:KATHLEEN
Mailing Address - State:GA
Mailing Address - Zip Code:31047-2139
Mailing Address - Country:US
Mailing Address - Phone:478-218-2219
Mailing Address - Fax:
Practice Address - Street 1:155 COLLEGE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7206
Practice Address - Country:US
Practice Address - Phone:478-741-3688
Practice Address - Fax:478-741-0912
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008899124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist