Provider Demographics
NPI:1790783595
Name:WHITE, BERNT E (DMD)
Entity Type:Individual
Prefix:DR
First Name:BERNT
Middle Name:E
Last Name:WHITE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 W IDAHO AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-2344
Mailing Address - Country:US
Mailing Address - Phone:541-889-8837
Mailing Address - Fax:541-889-8991
Practice Address - Street 1:347 W IDAHO AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2344
Practice Address - Country:US
Practice Address - Phone:541-889-8837
Practice Address - Fax:541-889-8991
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR81311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice