Provider Demographics
NPI:1154765907
Name:WHITE, HARLAN LEE (DMD)
Entity type:Individual
Prefix:
First Name:HARLAN
Middle Name:LEE
Last Name:WHITE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 PHILLIPS ST
Mailing Address - Street 2:PO BOX 732
Mailing Address - City:CANYONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97417-8703
Mailing Address - Country:US
Mailing Address - Phone:541-839-4800
Mailing Address - Fax:541-839-4800
Practice Address - Street 1:115 PHILLIPS ST
Practice Address - Street 2:PO BX 732
Practice Address - City:CANYONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97417-8703
Practice Address - Country:US
Practice Address - Phone:541-839-4800
Practice Address - Fax:541-839-4800
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4569122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist