Provider Demographics
NPI:1720196900
Name:WHITE, KAREN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:J
Last Name:WHITE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:KAREN WHITE
Mailing Address - Street 1:2036 HORNBLEND ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-4638
Mailing Address - Country:US
Mailing Address - Phone:858-270-6711
Mailing Address - Fax:
Practice Address - Street 1:2036 HORNBLEND
Practice Address - Street 2:
Practice Address - City:PACIFIC BEACH
Practice Address - State:CA
Practice Address - Zip Code:92109
Practice Address - Country:US
Practice Address - Phone:858-270-6711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA7493122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1119909Medicaid
IA50060OtherBCBS