Provider Demographics
NPI:1598907305
Name:JOHN R WHITE DDS AND CHRISTOPHER N SIACHOS DMD PA
Entity Type:Organization
Organization Name:JOHN R WHITE DDS AND CHRISTOPHER N SIACHOS DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:864-271-4006
Mailing Address - Street 1:1352 CLEVELAND ST STE A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2437
Mailing Address - Country:US
Mailing Address - Phone:864-271-4006
Mailing Address - Fax:
Practice Address - Street 1:1352 CLEVELAND ST STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2437
Practice Address - Country:US
Practice Address - Phone:864-271-4006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-26
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28421223G0001X
SC37791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty