Provider Demographics
NPI:1184941320
Name:WHITE, DAN RIDDLE (DDS)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:RIDDLE
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 1:1800 SOUTH PACIFIC
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:TX
Mailing Address - Zip Code:75773
Mailing Address - Country:US
Mailing Address - Phone:903-569-5569
Mailing Address - Fax:903-569-1601
Practice Address - Street 1:1800 SOUTH PACIFIC
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:TX
Practice Address - Zip Code:75773
Practice Address - Country:US
Practice Address - Phone:903-569-5569
Practice Address - Fax:903-569-1601
Is Sole Proprietor?:No
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7163122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist