Provider Demographics
NPI:1326066721
Name:WHITE, STEPHEN PATRICK (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:PATRICK
Last Name:WHITE
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5355 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-3333
Mailing Address - Country:US
Mailing Address - Phone:208-853-4687
Mailing Address - Fax:
Practice Address - Street 1:5355 W STATE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-3333
Practice Address - Country:US
Practice Address - Phone:208-853-4687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK14131223G0001X, 1223G0001X
TX259321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice