Provider Demographics
NPI:1679580575
Name:WHITE, STUART C (DDS)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:C
Last Name:WHITE
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:10833 LE CONTE AVE. CHS 10-165
Mailing Address - Street 2:BOX 951668
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1668
Mailing Address - Country:US
Mailing Address - Phone:310-825-5634
Mailing Address - Fax:310-206-2748
Practice Address - Street 1:10833 LE CONTE AVE. CHS 10-165
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1668
Practice Address - Country:US
Practice Address - Phone:310-825-5634
Practice Address - Fax:310-206-2748
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAD200821223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD20082AMedicare UPIN