Provider Demographics
NPI:1558445999
Name:WHITE, JIMMY CLEVELAND (DMD)
Entity Type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:CLEVELAND
Last Name:WHITE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 W ALABAMA ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:AL
Mailing Address - Zip Code:36904-2211
Mailing Address - Country:US
Mailing Address - Phone:205-459-3836
Mailing Address - Fax:205-459-3838
Practice Address - Street 1:123 W ALABAMA ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:AL
Practice Address - Zip Code:36904-2211
Practice Address - Country:US
Practice Address - Phone:205-459-3836
Practice Address - Fax:205-459-3838
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL32871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice