Provider Demographics
NPI:1962445247
Name:WHITE, WILLIAM MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MICHAEL
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 1:225 GOODING ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LA SALLE
Mailing Address - State:IL
Mailing Address - Zip Code:61301
Mailing Address - Country:US
Mailing Address - Phone:815-224-1865
Mailing Address - Fax:
Practice Address - Street 1:225 GOODING ST
Practice Address - Street 2:SUITE 1
Practice Address - City:LA SALLE
Practice Address - State:IL
Practice Address - Zip Code:61301
Practice Address - Country:US
Practice Address - Phone:815-224-1865
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1004181Medicaid