Provider Demographics
NPI:1316199268
Name:WHITE, KENNETH FRANCIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:FRANCIS
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 1:6273 ANNAPURNA DR
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-5332
Mailing Address - Country:US
Mailing Address - Phone:720-369-1812
Mailing Address - Fax:
Practice Address - Street 1:6273 ANNAPURNA DR
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-5332
Practice Address - Country:US
Practice Address - Phone:720-369-1812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX158361223G0001X
CO75831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice