Provider Demographics
NPI:1477191021
Name:WHITE, SPENCER (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 MEDALLION DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-2118
Mailing Address - Country:US
Mailing Address - Phone:662-453-4545
Mailing Address - Fax:
Practice Address - Street 1:914 MEDALLION DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-2118
Practice Address - Country:US
Practice Address - Phone:662-453-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3942-171223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty