Provider Demographics
NPI:1346521275
Name:JOHNATHAN R. WHITE DDS LLC
Entity Type:Organization
Organization Name:JOHNATHAN R. WHITE DDS LLC
Other - Org Name:AESTHETIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNATHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-823-3000
Mailing Address - Street 1:8084 W SAHARA AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2073
Mailing Address - Country:US
Mailing Address - Phone:702-823-3000
Mailing Address - Fax:702-685-8254
Practice Address - Street 1:8084 W SAHARA AVE
Practice Address - Street 2:SUITE G
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2073
Practice Address - Country:US
Practice Address - Phone:702-823-3000
Practice Address - Fax:702-685-8254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV55561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty