Provider Demographics
NPI:1992164388
Name:ROBERT D WHITE DDS
Entity type:Organization
Organization Name:ROBERT D WHITE DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-847-9521
Mailing Address - Street 1:PO BOX 319
Mailing Address - Street 2:140 JOE WIMBERLEY BLVD
Mailing Address - City:WIMBERLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78676-0319
Mailing Address - Country:US
Mailing Address - Phone:512-847-9521
Mailing Address - Fax:512-847-6185
Practice Address - Street 1:140 JOE WIMBERLEY BLVD
Practice Address - Street 2:
Practice Address - City:WIMBERLEY
Practice Address - State:TX
Practice Address - Zip Code:78676-0319
Practice Address - Country:US
Practice Address - Phone:512-847-9521
Practice Address - Fax:512-847-6185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13423122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX31152OtherSTATE LICENSE NUMBER
TX013423OtherSTATE LICENSE