Healthcare Provider Details

I. General information

NPI: 1154899201
Provider Name (Legal Business Name): WHITE SMILES FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2018
Last Update Date: 11/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 MARKET ST
FORT KENT ME
04743-1410
US

IV. Provider business mailing address

206 MAIN ST
FORT FAIRFIELD ME
04742-1121
US

V. Phone/Fax

Practice location:
  • Phone: 207-834-3907
  • Fax:
Mailing address:
  • Phone: 207-473-7723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH WHITE
Title or Position: OWNER
Credential: DMD
Phone: 207-473-7723