Provider Demographics
NPI:1588992663
Name:DR. C. R. WHITE AND ASSOCIATES DENTAL CENTER,INC.
Entity type:Organization
Organization Name:DR. C. R. WHITE AND ASSOCIATES DENTAL CENTER,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARICE
Authorized Official - Middle Name:R
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:731-548-2400
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:TN
Mailing Address - Zip Code:38069-0310
Mailing Address - Country:US
Mailing Address - Phone:731-548-2400
Mailing Address - Fax:731-548-2099
Practice Address - Street 1:17 1ST ST E
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:TN
Practice Address - Zip Code:38069-4426
Practice Address - Country:US
Practice Address - Phone:731-548-2400
Practice Address - Fax:731-548-2099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8059122300000X
TN11357126800000X
TN13532126800000X
TN5088122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1013062249Medicare UPIN
TN1891776845Medicare UPIN