Provider Demographics
NPI:1215157953
Name:WHITE, FREDRIC J (DDS)
Entity type:Individual
Prefix:DR
First Name:FREDRIC
Middle Name:J
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 1:2151 S HIGHWAY 92 STE 109
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-5283
Mailing Address - Country:US
Mailing Address - Phone:520-730-8388
Mailing Address - Fax:
Practice Address - Street 1:2151 S HIGHWAY 92 STE 109
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-5283
Practice Address - Country:US
Practice Address - Phone:520-730-8388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD030491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice