Provider Demographics
NPI:1063602019
Name:WHITE SPRUCE DENTAL,PLLC
Entity type:Organization
Organization Name:WHITE SPRUCE DENTAL,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:D
Authorized Official - Last Name:NOZIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-424-5120
Mailing Address - Street 1:935 E HENRIETTA RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-1409
Mailing Address - Country:US
Mailing Address - Phone:585-424-5120
Mailing Address - Fax:585-424-1743
Practice Address - Street 1:935 E HENRIETTA RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1409
Practice Address - Country:US
Practice Address - Phone:585-424-5120
Practice Address - Fax:585-424-1743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038751122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty