Provider Demographics
NPI:1447391321
Name:WHITE, ELI E (DDS)
Entity Type:Individual
Prefix:
First Name:ELI
Middle Name:E
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 1:6050 BABCOCK ST SE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-3996
Mailing Address - Country:US
Mailing Address - Phone:321-725-9946
Mailing Address - Fax:321-951-7389
Practice Address - Street 1:6050 BABCOCK ST SE
Practice Address - Street 2:SUITE 2
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-3996
Practice Address - Country:US
Practice Address - Phone:321-725-9946
Practice Address - Fax:321-951-7389
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN30381223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN3038OtherLICENSE NUMBER