Provider Demographics
NPI:1902357544
Name:WHITE FAMILY DENTAL - WILLOW STREET
Entity Type:Organization
Organization Name:WHITE FAMILY DENTAL - WILLOW STREET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:717-367-1336
Mailing Address - Street 1:100 CONTINENTAL DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-2260
Mailing Address - Country:US
Mailing Address - Phone:717-740-2200
Mailing Address - Fax:717-205-2090
Practice Address - Street 1:212 WILLOW VALLEY DRIVE
Practice Address - Street 2:SUITE 209
Practice Address - City:WILLOW STREET
Practice Address - State:PA
Practice Address - Zip Code:17584
Practice Address - Country:US
Practice Address - Phone:717-740-2200
Practice Address - Fax:717-205-2090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023279L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty