Provider Demographics
NPI:1649889635
Name:WHITE, NICHOLAS EUGENE (DDS)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:EUGENE
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 1:1530 CENTENNIAL CT
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-7304
Mailing Address - Country:US
Mailing Address - Phone:307-265-9463
Mailing Address - Fax:307-265-3447
Practice Address - Street 1:1530 CENTENNIAL CT
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-7304
Practice Address - Country:US
Practice Address - Phone:307-265-9463
Practice Address - Fax:307-265-3447
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY15571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice