Provider Demographics
NPI:1588763031
Name:WHITE, STEPHANIE R (DMD LLC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R
Last Name:WHITE
Suffix:
Gender:F
Credentials:DMD LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3965 HIGHWAY 101 N
Mailing Address - Street 2:
Mailing Address - City:GEARHART
Mailing Address - State:OR
Mailing Address - Zip Code:97138-4327
Mailing Address - Country:US
Mailing Address - Phone:503-738-9273
Mailing Address - Fax:503-717-9323
Practice Address - Street 1:3965 HIGHWAY 101 N
Practice Address - Street 2:
Practice Address - City:GEARHART
Practice Address - State:OR
Practice Address - Zip Code:97138-4327
Practice Address - Country:US
Practice Address - Phone:503-738-9273
Practice Address - Fax:503-717-9323
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD86091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice