Healthcare Provider Details

I. General information

NPI: 1104960160
Provider Name (Legal Business Name): JAMES GREGORY WHITE D.M.D., M.S.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 W 8TH ST
LONDON KY
40741-1714
US

IV. Provider business mailing address

105 SPRUCE ST
LEXINGTON KY
40507-2109
US

V. Phone/Fax

Practice location:
  • Phone: 606-877-1900
  • Fax: 606-877-1755
Mailing address:
  • Phone: 859-300-3911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6263
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: