Provider Demographics
NPI:1316607229
Name:WHITE COSMETIC AND FAMILY DENTISTRY, PLLC.
Entity type:Organization
Organization Name:WHITE COSMETIC AND FAMILY DENTISTRY, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:VANCE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-663-5538
Mailing Address - Street 1:8126 S MINGO RD STE 105
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4578
Mailing Address - Country:US
Mailing Address - Phone:918-663-5538
Mailing Address - Fax:918-627-9985
Practice Address - Street 1:8126 S MINGO RD STE 105
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4578
Practice Address - Country:US
Practice Address - Phone:918-663-5538
Practice Address - Fax:918-627-9985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty