Provider Demographics
NPI:1215795505
Name:WHITE, ROBERT CHARLES JR (DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:CHARLES
Last Name:WHITE
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:CHARLES
Other - Last Name:WHITE
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:539 W 120TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-3901
Mailing Address - Country:US
Mailing Address - Phone:310-978-5523
Mailing Address - Fax:
Practice Address - Street 1:1509 HAWTHORNE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-3957
Practice Address - Country:US
Practice Address - Phone:424-383-6245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS112116122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist