Provider Demographics
NPI:1376664607
Name:WHITE, SUSAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5507 MONROE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-5503
Mailing Address - Country:US
Mailing Address - Phone:704-535-0782
Mailing Address - Fax:704-535-8371
Practice Address - Street 1:5507 MONROE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-5503
Practice Address - Country:US
Practice Address - Phone:704-535-0782
Practice Address - Fax:704-535-8371
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC75031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice