Healthcare Provider Details

I. General information

NPI: 1093258162
Provider Name (Legal Business Name): JAMES L. WHITE DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2016
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 US HIGHWAY 17 N
HOLLY RIDGE NC
28445-7826
US

IV. Provider business mailing address

PO BOX 279
HOLLY RIDGE NC
28445-0279
US

V. Phone/Fax

Practice location:
  • Phone: 910-329-8191
  • Fax: 910-329-0202
Mailing address:
  • Phone: 910-329-8191
  • Fax: 910-329-0202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6641
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES LANKFORD WHITE
Title or Position: DOCTOR/ OWNER
Credential: DDS, PA
Phone: 910-329-8191