Provider Demographics
NPI:1265117519
Name:WHITE, LENA ADELLE (DMD)
Entity type:Individual
Prefix:DR
First Name:LENA
Middle Name:ADELLE
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:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:GA
Mailing Address - Zip Code:30413-0008
Mailing Address - Country:US
Mailing Address - Phone:912-220-9037
Mailing Address - Fax:
Practice Address - Street 1:1962 US HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-6463
Practice Address - Country:US
Practice Address - Phone:912-756-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.104911223G0001X
GADN1230741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice