Provider Demographics
NPI:1265027304
Name:JAMIE R WHITE DMD PC
Entity Type:Organization
Organization Name:JAMIE R WHITE DMD PC
Other - Org Name:PHOENIX FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-535-4142
Mailing Address - Street 1:205 N PHOENIX RD STE 410
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:OR
Mailing Address - Zip Code:97535-9104
Mailing Address - Country:US
Mailing Address - Phone:541-535-4142
Mailing Address - Fax:541-535-3415
Practice Address - Street 1:205 N PHOENIX RD STE 410
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:OR
Practice Address - Zip Code:97535-9104
Practice Address - Country:US
Practice Address - Phone:541-535-4142
Practice Address - Fax:541-535-3415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-01
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1437230521OtherNPI