Healthcare Provider Details

I. General information

NPI: 1962445247
Provider Name (Legal Business Name): WILLIAM MICHAEL WHITE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 GOODING ST SUITE 1
LA SALLE IL
61301
US

IV. Provider business mailing address

225 GOODING ST SUITE 1
LA SALLE IL
61301
US

V. Phone/Fax

Practice location:
  • Phone: 815-224-1865
  • Fax:
Mailing address:
  • Phone: 815-224-1865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: