Provider Demographics
NPI:1699427807
Name:WHITE OAK FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:WHITE OAK FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST/OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:MECHAY
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-586-4982
Mailing Address - Street 1:1905 OXMOOR RD
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-3502
Mailing Address - Country:US
Mailing Address - Phone:205-870-3055
Mailing Address - Fax:205-870-3056
Practice Address - Street 1:1905 OXMOOR RD
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-3502
Practice Address - Country:US
Practice Address - Phone:205-870-3055
Practice Address - Fax:205-870-3056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental