Healthcare Provider Details

I. General information

NPI: 1245607225
Provider Name (Legal Business Name): CHRISTOPHER WHITE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2015
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 E WILCOX AVE
WHITE CLOUD MI
49349-8794
US

IV. Provider business mailing address

1140 N STATE ST
SAINT IGNACE MI
49781-1048
US

V. Phone/Fax

Practice location:
  • Phone: 231-689-1608
  • Fax: 231-745-0412
Mailing address:
  • Phone: 906-643-8689
  • Fax: 906-643-6716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901021646
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: