Provider Demographics
NPI:1932316817
Name:WHITE OAK DENTAL LLC
Entity Type:Organization
Organization Name:WHITE OAK DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALONZO
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:301-681-6306
Mailing Address - Street 1:11247 LOCKWOOD DR STE A
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4561
Mailing Address - Country:US
Mailing Address - Phone:301-681-6306
Mailing Address - Fax:301-681-6101
Practice Address - Street 1:11247 LOCKWOOD DR STE A
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4561
Practice Address - Country:US
Practice Address - Phone:301-681-6306
Practice Address - Fax:301-681-6101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD102651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty