Provider Demographics
NPI:1972775740
Name:DR. W. DAVID WHITE, DDS, PA
Entity type:Organization
Organization Name:DR. W. DAVID WHITE, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-869-9661
Mailing Address - Street 1:3044 E FRANKLIN BLVD
Mailing Address - Street 2:STE. 4
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-5400
Mailing Address - Country:US
Mailing Address - Phone:704-869-9661
Mailing Address - Fax:704-869-9698
Practice Address - Street 1:3044 E FRANKLIN BLVD
Practice Address - Street 2:STE. 4
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-5400
Practice Address - Country:US
Practice Address - Phone:704-869-9661
Practice Address - Fax:704-869-9698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC72371223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty