Provider Demographics
NPI:1689787178
Name:WHITE, ALAN LEO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:LEO
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 1:202 N. MAIN ST.
Mailing Address - Street 2:BOX 35
Mailing Address - City:LYNN
Mailing Address - State:IN
Mailing Address - Zip Code:47355-0035
Mailing Address - Country:US
Mailing Address - Phone:765-874-2571
Mailing Address - Fax:
Practice Address - Street 1:202 N. MAIN ST.
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:IN
Practice Address - Zip Code:47355-0035
Practice Address - Country:US
Practice Address - Phone:765-874-2571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist