Provider Demographics
NPI:1386049948
Name:WHITE SMILES FAMILY DENTISTRY
Entity type:Organization
Organization Name:WHITE SMILES FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-515-3615
Mailing Address - Street 1:2074 PONDEROSA PL
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-7524
Mailing Address - Country:US
Mailing Address - Phone:985-630-2306
Mailing Address - Fax:
Practice Address - Street 1:6563 LAKETOWNE PL
Practice Address - Street 2:A
Practice Address - City:ALBERTVILLE
Practice Address - State:MN
Practice Address - Zip Code:55301-4510
Practice Address - Country:US
Practice Address - Phone:985-630-2306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-24
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13202122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty