Provider Demographics
NPI:1285732842
Name:WHITE, SHERRY D (RDA)
Entity type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:D
Last Name:WHITE
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 94
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-0094
Mailing Address - Country:US
Mailing Address - Phone:731-925-9624
Mailing Address - Fax:731-925-5303
Practice Address - Street 1:165 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-2078
Practice Address - Country:US
Practice Address - Phone:731-925-4971
Practice Address - Fax:731-925-5303
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDA0000003538126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant