Provider Demographics
NPI:1568163871
Name:WHITE, KALLIE S (RDH)
Entity Type:Individual
Prefix:
First Name:KALLIE
Middle Name:S
Last Name:WHITE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:KALLIE
Other - Middle Name:S
Other - Last Name:ZINNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:123 S 27TH ST
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-4227
Mailing Address - Country:US
Mailing Address - Phone:406-247-3333
Mailing Address - Fax:406-247-3334
Practice Address - Street 1:123 S 27TH ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-4227
Practice Address - Country:US
Practice Address - Phone:406-247-3333
Practice Address - Fax:406-247-3334
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT23683124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist