Healthcare Provider Details

I. General information

NPI: 1073888418
Provider Name (Legal Business Name): STEPHEN WHITE DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 03/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44539 STERLING HWY STE 203
SOLDOTNA AK
99669-7920
US

IV. Provider business mailing address

44539 STERLING HWY STE 203
SOLDOTNA AK
99669-7920
US

V. Phone/Fax

Practice location:
  • Phone: 907-262-8834
  • Fax:
Mailing address:
  • Phone: 907-262-8834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number1413
License Number StateAK

VIII. Authorized Official

Name: DR. STEPHEN PATRICK WHITE
Title or Position: MANAGER
Credential: DDS
Phone: 907-262-8834