Provider Demographics
NPI:1861445678
Name:WHITE, SANDER IRWIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SANDER
Middle Name:IRWIN
Last Name:WHITE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2193 W CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3029
Mailing Address - Country:US
Mailing Address - Phone:610-353-6161
Mailing Address - Fax:610-353-0562
Practice Address - Street 1:2193 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3029
Practice Address - Country:US
Practice Address - Phone:610-353-6161
Practice Address - Fax:610-353-0562
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0174661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice