Provider Demographics
NPI:1508220070
Name:WHITE HOUSE DENTAL, PLLC
Entity Type:Organization
Organization Name:WHITE HOUSE DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:615-581-5000
Mailing Address - Street 1:323 WEST DR
Mailing Address - Street 2:
Mailing Address - City:WHITE HOUSE
Mailing Address - State:TN
Mailing Address - Zip Code:37188-9294
Mailing Address - Country:US
Mailing Address - Phone:615-581-5000
Mailing Address - Fax:615-672-0096
Practice Address - Street 1:323 WEST DR
Practice Address - Street 2:
Practice Address - City:WHITE HOUSE
Practice Address - State:TN
Practice Address - Zip Code:37188-9294
Practice Address - Country:US
Practice Address - Phone:615-581-5000
Practice Address - Fax:615-672-0096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9273122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty