Healthcare Provider Details

I. General information

NPI: 1174043657
Provider Name (Legal Business Name): JEFFREY LEE WHITE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4374 ATLANTA HWY STE 111
HIRAM GA
30141-1849
US

IV. Provider business mailing address

4925 JEFFERSON AVE
MIDLAND MI
48640-2905
US

V. Phone/Fax

Practice location:
  • Phone: 770-222-2322
  • Fax:
Mailing address:
  • Phone: 989-600-9837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN123000
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: