Provider Demographics
NPI:1407934607
Name:WHITE, SCOT B (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOT
Middle Name:B
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 1:1717 E MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933
Mailing Address - Country:US
Mailing Address - Phone:765-362-5341
Mailing Address - Fax:765-362-5348
Practice Address - Street 1:1717 EAST MAIN ST.
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933
Practice Address - Country:US
Practice Address - Phone:765-362-5341
Practice Address - Fax:765-362-5348
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009418122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100185810AMedicaid
IN110346OtherUNITED CONCORDIA