Provider Demographics
NPI:1720103559
Name:WHITE, LINDA ROSE (DMD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:ROSE
Last Name:WHITE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14622
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-4622
Mailing Address - Country:US
Mailing Address - Phone:850-385-6117
Mailing Address - Fax:850-385-8306
Practice Address - Street 1:1211 W THARPE ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-4607
Practice Address - Country:US
Practice Address - Phone:850-385-6117
Practice Address - Fax:850-385-8306
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice