Provider Demographics
NPI:1427490234
Name:HALLEY WHITE,DDS, PA
Entity type:Organization
Organization Name:HALLEY WHITE,DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:HALLEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,PA
Authorized Official - Phone:910-686-1869
Mailing Address - Street 1:8115 MARKET ST
Mailing Address - Street 2:STE 204
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-8427
Mailing Address - Country:US
Mailing Address - Phone:910-686-1869
Mailing Address - Fax:
Practice Address - Street 1:8115 MARKET ST
Practice Address - Street 2:STE 204
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-8427
Practice Address - Country:US
Practice Address - Phone:910-686-1869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC76671223P0221X
MS72761223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5920762Medicaid
NC5904426Medicaid