Provider Demographics
NPI:1528029733
Name:WHITE, DALE MICHAEL (DDS)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:MICHAEL
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:FAMILY HEALTHCARE, INC.
Mailing Address - Street 2:62 CHARLES STREET
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701
Mailing Address - Country:US
Mailing Address - Phone:740-447-8734
Mailing Address - Fax:740-775-7855
Practice Address - Street 1:FAMILY HEALTHCARE, INC.
Practice Address - Street 2:62 CHARLES STREET
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701
Practice Address - Country:US
Practice Address - Phone:740-447-8734
Practice Address - Fax:740-775-7855
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300133891223G0001X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0501871Medicaid
OH0203452Medicaid