Provider Demographics
NPI:1417176611
Name:WHITE, DARYLL HOFFMAN (DDS)
Entity Type:Individual
Prefix:
First Name:DARYLL
Middle Name:HOFFMAN
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 1:6809 TEMPLE HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-5205
Mailing Address - Country:US
Mailing Address - Phone:301-449-5141
Mailing Address - Fax:
Practice Address - Street 1:6809 TEMPLE HILL ROAD
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-5205
Practice Address - Country:US
Practice Address - Phone:301-449-5141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD092381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice