Provider Demographics
NPI:1679939995
Name:WHITE OAK DENTAL OFFICE PLLC
Entity Type:Organization
Organization Name:WHITE OAK DENTAL OFFICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:931-879-5834
Mailing Address - Street 1:214 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38556-3748
Mailing Address - Country:US
Mailing Address - Phone:931-879-5834
Mailing Address - Fax:931-879-3811
Practice Address - Street 1:214 N MAIN ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:TN
Practice Address - Zip Code:38556-3748
Practice Address - Country:US
Practice Address - Phone:931-879-5834
Practice Address - Fax:931-879-3811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS98461223G0001X
TNDS79821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty