Healthcare Provider Details

I. General information

NPI: 1518020122
Provider Name (Legal Business Name): CHRISTOPHER J. WHITE D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 WHITTLE CIR
ASHBURN GA
31714-1918
US

IV. Provider business mailing address

274 WHITTLE CIR
ASHBURN GA
31714-1918
US

V. Phone/Fax

Practice location:
  • Phone: 229-567-4316
  • Fax: 229-567-4316
Mailing address:
  • Phone: 229-567-4316
  • Fax: 229-567-4316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN009604
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: