Provider Demographics
NPI:1710319884
Name:GENEVA WHITE DMD PA
Entity Type:Organization
Organization Name:GENEVA WHITE DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GENEVA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-434-4344
Mailing Address - Street 1:5970 S JOG RD STE E
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-6576
Mailing Address - Country:US
Mailing Address - Phone:561-434-4344
Mailing Address - Fax:561-434-3634
Practice Address - Street 1:5970 S JOG RD STE E
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-6576
Practice Address - Country:US
Practice Address - Phone:561-434-4344
Practice Address - Fax:561-434-3634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12984122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty