Healthcare Provider Details

I. General information

NPI: 1164482204
Provider Name (Legal Business Name): ANTHONY L. WHITE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4780 S KIRKMAN RD
ORLANDO FL
32811-3643
US

IV. Provider business mailing address

926 GREAT POND DR SUITE 2003
ALTAMONTE SPRINGS FL
32714-7244
US

V. Phone/Fax

Practice location:
  • Phone: 407-292-7373
  • Fax: 407-292-5127
Mailing address:
  • Phone: 407-772-5124
  • Fax: 407-788-3572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN17307
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: