Provider Demographics
NPI:1396798468
Name:WHITE, ALLEN HARDIN III (DDS)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:HARDIN
Last Name:WHITE
Suffix:III
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 1:1117 DITCHLEY RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-3758
Mailing Address - Country:US
Mailing Address - Phone:757-417-7247
Mailing Address - Fax:757-428-3470
Practice Address - Street 1:501 21ST ST
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-4118
Practice Address - Country:US
Practice Address - Phone:757-428-6656
Practice Address - Fax:757-428-3470
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010088571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice