Provider Demographics
NPI:1326306945
Name:WHITE DENTAL, LLC
Entity Type:Organization
Organization Name:WHITE DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HYUN-WON
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-263-7791
Mailing Address - Street 1:800 SILVER LANE
Mailing Address - Street 2:SUITE#222
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06118-1233
Mailing Address - Country:US
Mailing Address - Phone:860-263-7791
Mailing Address - Fax:860-216-0316
Practice Address - Street 1:800 SILVER LANE
Practice Address - Street 2:SUITE#222
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06118-1233
Practice Address - Country:US
Practice Address - Phone:860-263-7791
Practice Address - Fax:860-216-0316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0094101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty