Provider Demographics
NPI:1639214299
Name:WHITE OAK DENTAL PLLC
Entity Type:Organization
Organization Name:WHITE OAK DENTAL PLLC
Other - Org Name:WHITE OAK DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOURAISH
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAOUD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:517-851-8902
Mailing Address - Street 1:2600 N M 52
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:MI
Mailing Address - Zip Code:49285-9766
Mailing Address - Country:US
Mailing Address - Phone:517-851-8902
Mailing Address - Fax:517-851-9241
Practice Address - Street 1:2600 N M 52
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:MI
Practice Address - Zip Code:49285-9766
Practice Address - Country:US
Practice Address - Phone:517-851-8902
Practice Address - Fax:517-851-9241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI189241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty