Provider Demographics
NPI:1548243355
Name:WHITE, DAVID K
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:K
Last Name:WHITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 MARE ISLAND WAY
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-5805
Mailing Address - Country:US
Mailing Address - Phone:707-552-2228
Mailing Address - Fax:707-553-9847
Practice Address - Street 1:285 MARE ISLAND WAY
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-5805
Practice Address - Country:US
Practice Address - Phone:707-552-2228
Practice Address - Fax:707-553-9847
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA298561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice