Provider Demographics
NPI:1801030044
Name:MICHAEL J. WHITE DDS INC
Entity Type:Organization
Organization Name:MICHAEL J. WHITE DDS INC
Other - Org Name:FUN ZONE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-596-8056
Mailing Address - Street 1:5482 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 154
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4218
Mailing Address - Country:US
Mailing Address - Phone:213-596-8056
Mailing Address - Fax:
Practice Address - Street 1:2002 S HOOVER ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-1323
Practice Address - Country:US
Practice Address - Phone:213-596-8056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA342571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty