Provider Demographics
NPI:1982134094
Name:WHITE, VANESSA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:M
Last Name:WHITE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6018 WAXHAW CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-2401
Mailing Address - Country:US
Mailing Address - Phone:919-619-1404
Mailing Address - Fax:
Practice Address - Street 1:460 KILLIAN RD # 1
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-9751
Practice Address - Country:US
Practice Address - Phone:803-814-0102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8927122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist