Provider Demographics
NPI:1255359493
Name:WHITE, EDWIN ALEXANDER (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:ALEXANDER
Last Name:WHITE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:E ALEXANDER
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:5500 WHITESIDE RD
Mailing Address - Street 2:
Mailing Address - City:SANDSTON
Mailing Address - State:VA
Mailing Address - Zip Code:23150-2345
Mailing Address - Country:US
Mailing Address - Phone:804-737-4444
Mailing Address - Fax:804-328-2865
Practice Address - Street 1:45C W WILLIAMSBURG RD
Practice Address - Street 2:
Practice Address - City:SANDSTON
Practice Address - State:VA
Practice Address - Zip Code:23150-2040
Practice Address - Country:US
Practice Address - Phone:804-737-4444
Practice Address - Fax:804-328-2865
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410560122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist