Healthcare Provider Details

I. General information

NPI: 1124032578
Provider Name (Legal Business Name): DANIEL E WHITE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 N 3RD ST
GOSHEN IN
46528-7100
US

IV. Provider business mailing address

814 N 3RD ST
GOSHEN IN
46528-7100
US

V. Phone/Fax

Practice location:
  • Phone: 574-500-3737
  • Fax: 574-971-8434
Mailing address:
  • Phone: 574-500-3737
  • Fax: 574-971-8434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12007822A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: