Provider Demographics
NPI:1013925940
Name:WHITE, GENEVA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:GENEVA
Middle Name:M
Last Name:WHITE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5970 JOG RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467
Mailing Address - Country:US
Mailing Address - Phone:561-434-4344
Mailing Address - Fax:561-434-3634
Practice Address - Street 1:5970 JOG RD
Practice Address - Street 2:SUITE E
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467
Practice Address - Country:US
Practice Address - Phone:561-434-4344
Practice Address - Fax:561-434-3634
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12984122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist