Provider Demographics
NPI:1639195787
Name:WHITE, MORI KENT (DDS)
Entity Type:Individual
Prefix:MR
First Name:MORI
Middle Name:KENT
Last Name:WHITE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 8TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-6722
Mailing Address - Country:US
Mailing Address - Phone:580-256-4301
Mailing Address - Fax:580-256-1437
Practice Address - Street 1:2802 8TH ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-6722
Practice Address - Country:US
Practice Address - Phone:580-256-4301
Practice Address - Fax:580-256-1437
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5088122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS516578OtherBC & BS OF KS
OK731410006001OtherBC & BS OF OK
OK727118OtherUNITED CONCORDIA