Provider Demographics
NPI:1891822474
Name:WHITE, JAMES DEREK (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DEREK
Last Name:WHITE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 WOODGREEN PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-8161
Mailing Address - Country:US
Mailing Address - Phone:601-605-5015
Mailing Address - Fax:601-605-6440
Practice Address - Street 1:1 WOODGREEN PL
Practice Address - Street 2:SUITE 100
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-8161
Practice Address - Country:US
Practice Address - Phone:601-605-5015
Practice Address - Fax:601-605-6440
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3242-021223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics