Provider Demographics
NPI:1508359787
Name:WHITE, JANE HARRISON (DMD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:HARRISON
Last Name:WHITE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:COLVIN
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4849 GREENVILLE AVE STE 173
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-4187
Mailing Address - Country:US
Mailing Address - Phone:214-369-9966
Mailing Address - Fax:214-368-0809
Practice Address - Street 1:4849 GREENVILLE AVE STE 173
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-4187
Practice Address - Country:US
Practice Address - Phone:214-369-9966
Practice Address - Fax:214-368-0809
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012946A122300000X
TX36027122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist