Provider Demographics
NPI:1932370210
Name:WHITE, MERLE STANLEY (DDS)
Entity Type:Individual
Prefix:
First Name:MERLE
Middle Name:STANLEY
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 1:2104 WINDSOR PLACE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAVOY
Mailing Address - State:IL
Mailing Address - Zip Code:61874
Mailing Address - Country:US
Mailing Address - Phone:217-351-2990
Mailing Address - Fax:217-351-9864
Practice Address - Street 1:2104 WINDSOR PLACE
Practice Address - Street 2:SUITE B
Practice Address - City:SAVOY
Practice Address - State:IL
Practice Address - Zip Code:61874
Practice Address - Country:US
Practice Address - Phone:217-351-2990
Practice Address - Fax:217-351-9864
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist