Provider Demographics
NPI:1326693243
Name:WHITE, ZACHARY DANIEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:DANIEL
Last Name:WHITE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIT 31401 BOX 28
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09630-1401
Mailing Address - Country:US
Mailing Address - Phone:314-636-9874
Mailing Address - Fax:
Practice Address - Street 1:US ARMY DENTAC
Practice Address - Street 2:9900 LINCOLN ST 2ND FLOOR
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98327
Practice Address - Country:US
Practice Address - Phone:253-967-5271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD11118122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice