Provider Demographics
NPI:1720007594
Name:WHITE, RICHARD A (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:WHITE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:400 AVENUE K SE
Mailing Address - Street 2:SUITE #8
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-4146
Mailing Address - Country:US
Mailing Address - Phone:863-293-2562
Mailing Address - Fax:863-293-5658
Practice Address - Street 1:400 AVENUE K SE
Practice Address - Street 2:SUITE #8
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4146
Practice Address - Country:US
Practice Address - Phone:863-293-2562
Practice Address - Fax:863-293-5658
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL32591223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics