Provider Demographics
NPI:1568751683
Name:WHITE DENTAL, PLLC
Entity Type:Organization
Organization Name:WHITE DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:435-257-3210
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:TREMONTON
Mailing Address - State:UT
Mailing Address - Zip Code:84337-0236
Mailing Address - Country:US
Mailing Address - Phone:435-257-3210
Mailing Address - Fax:435-257-5436
Practice Address - Street 1:431 W 600 N
Practice Address - Street 2:
Practice Address - City:TREMONTON
Practice Address - State:UT
Practice Address - Zip Code:84337-2411
Practice Address - Country:US
Practice Address - Phone:435-257-3210
Practice Address - Fax:435-257-5436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty