Healthcare Provider Details

I. General information

NPI: 1548243355
Provider Name (Legal Business Name): DAVID K. WHITE
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 MARE ISLAND WAY
VALLEJO CA
94590-5805
US

IV. Provider business mailing address

285 MARE ISLAND WAY
VALLEJO CA
94590-5805
US

V. Phone/Fax

Practice location:
  • Phone: 707-552-2228
  • Fax: 707-553-9847
Mailing address:
  • Phone: 707-552-2228
  • Fax: 707-553-9847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number29856
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: