Healthcare Provider Details

I. General information

NPI: 1992233845
Provider Name (Legal Business Name): NATHAN BRANDON WHITE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 05/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 CENTRAL PKWY
MONTGOMERY AL
36106-3140
US

IV. Provider business mailing address

2000 2ND AVE S APT 522
BIRMINGHAM AL
35233-2088
US

V. Phone/Fax

Practice location:
  • Phone: 334-277-2424
  • Fax:
Mailing address:
  • Phone: 205-936-1621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberPENDING
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: