Provider Demographics
NPI:1437210077
Name:WHITE, TRESA C (DMD)
Entity Type:Individual
Prefix:DR
First Name:TRESA
Middle Name:C
Last Name:WHITE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 EAST 18TH STREET
Mailing Address - Street 2:P.O. BOX 1001
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42241-1001
Mailing Address - Country:US
Mailing Address - Phone:270-886-0581
Mailing Address - Fax:270-886-2547
Practice Address - Street 1:440 E 18TH ST
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-3676
Practice Address - Country:US
Practice Address - Phone:270-886-0581
Practice Address - Fax:270-886-2547
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY58581223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist