Provider Demographics
NPI:1992233845
Name:WHITE, NATHAN BRANDON (DMD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:BRANDON
Last Name:WHITE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 2ND AVE S APT 522
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-2088
Mailing Address - Country:US
Mailing Address - Phone:205-936-1621
Mailing Address - Fax:
Practice Address - Street 1:2415 CENTRAL PKWY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3140
Practice Address - Country:US
Practice Address - Phone:334-277-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPENDING122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist