Provider Demographics
NPI:1831381037
Name:WHITE, JASON EDWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:EDWARD
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 1:6565 STAGE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3830
Mailing Address - Country:US
Mailing Address - Phone:901-382-0280
Mailing Address - Fax:901-791-0955
Practice Address - Street 1:6565 STAGE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-3830
Practice Address - Country:US
Practice Address - Phone:901-382-4148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8733122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ013687Medicaid