Provider Demographics
NPI:1942749718
Name:WHITE, JORDAN RANSOME (DMD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:RANSOME
Last Name:WHITE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1595 VAUGHAN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:NC
Mailing Address - Zip Code:27862-7081
Mailing Address - Country:US
Mailing Address - Phone:252-578-8299
Mailing Address - Fax:
Practice Address - Street 1:3607 DAVIS DR STE 209
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-6005
Practice Address - Country:US
Practice Address - Phone:919-469-2122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC106651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program