Provider Demographics
NPI:1427383918
Name:WHITE, CAROLYN MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:MARIE
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 1:8910 UNIVERSITY CENTER LANE
Mailing Address - Street 2:SUITE 670
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122
Mailing Address - Country:US
Mailing Address - Phone:858-558-8590
Mailing Address - Fax:858-558-8614
Practice Address - Street 1:8910 UNIVERSITY CENTER LANE
Practice Address - Street 2:SUITE 670
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122
Practice Address - Country:US
Practice Address - Phone:858-558-8590
Practice Address - Fax:858-558-8614
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA373051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice