Provider Demographics
NPI:1437235546
Name:WHITE, CHARLES WESLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WESLEY
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 1:1235 W VISTA WAY
Mailing Address - Street 2:SUITE G
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6234
Mailing Address - Country:US
Mailing Address - Phone:760-941-2113
Mailing Address - Fax:760-941-1785
Practice Address - Street 1:1235 W VISTA WAY
Practice Address - Street 2:SUITE G
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6234
Practice Address - Country:US
Practice Address - Phone:760-941-2113
Practice Address - Fax:760-941-1785
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26562122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist