Provider Demographics
NPI:1821606674
Name:WHITE, WHITNEY OLIVIA (DDS)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:OLIVIA
Last Name:WHITE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4133 PEACEFUL MEADOW ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1588
Mailing Address - Country:US
Mailing Address - Phone:815-997-3633
Mailing Address - Fax:
Practice Address - Street 1:2050 E SERENE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-4820
Practice Address - Country:US
Practice Address - Phone:815-997-3633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-17
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV77351223G0001X
TX36324122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist