Healthcare Provider Details

I. General information

NPI: 1457586190
Provider Name (Legal Business Name): BRYAN ALAN WHITE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9660 E 22ND ST STE 160
TUCSON AZ
85748-7562
US

IV. Provider business mailing address

933 E JUANITA AVE
GILBERT AZ
85234-3521
US

V. Phone/Fax

Practice location:
  • Phone: 520-917-0670
  • Fax:
Mailing address:
  • Phone: 480-497-8140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD008354
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: