Provider Demographics
NPI:1285707679
Name:WHITE, DONALD W (DDS)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:W
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 1:3901 SOUTHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-3862
Mailing Address - Country:US
Mailing Address - Phone:765-455-0311
Mailing Address - Fax:765-455-1270
Practice Address - Street 1:3901 SOUTHLAND AVE
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3862
Practice Address - Country:US
Practice Address - Phone:765-455-0311
Practice Address - Fax:765-455-1270
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120085271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice