Provider Demographics
NPI:1104960160
Name:WHITE, JAMES GREGORY (DMD, MSD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GREGORY
Last Name:WHITE
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40507-2109
Mailing Address - Country:US
Mailing Address - Phone:859-300-3911
Mailing Address - Fax:
Practice Address - Street 1:118 W 8TH ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1714
Practice Address - Country:US
Practice Address - Phone:606-877-1900
Practice Address - Fax:606-877-1755
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY62631223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60062635Medicaid