Provider Demographics
NPI:1831577725
Name:WHITE, BENJAMIN CLARK (DDS)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:CLARK
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 1:402 NAVARRE ST
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-4134
Mailing Address - Country:US
Mailing Address - Phone:850-816-8787
Mailing Address - Fax:
Practice Address - Street 1:1108 N 12TH AVE
Practice Address - Street 2:SUITE C
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-3308
Practice Address - Country:US
Practice Address - Phone:850-912-8877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21409122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist