Provider Demographics
NPI:1518900547
Name:WHITE, BRYCE LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:LEE
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 1:16910A HIGHWAY 14
Mailing Address - Street 2:
Mailing Address - City:MOJAVE
Mailing Address - State:CA
Mailing Address - Zip Code:93501-1226
Mailing Address - Country:US
Mailing Address - Phone:661-824-4035
Mailing Address - Fax:
Practice Address - Street 1:16910A HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:MOJAVE
Practice Address - State:CA
Practice Address - Zip Code:93501-1226
Practice Address - Country:US
Practice Address - Phone:661-824-4035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28828122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist