Provider Demographics
NPI:1477736148
Name:WHITE, DARRELL JOSEPH (DDS)
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:JOSEPH
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 1:711-045 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96127-0790
Mailing Address - Country:US
Mailing Address - Phone:530-257-2181
Mailing Address - Fax:530-252-3003
Practice Address - Street 1:711-055 CENTER RD
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96127-0790
Practice Address - Country:US
Practice Address - Phone:530-257-2181
Practice Address - Fax:530-252-3003
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA322011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice