Healthcare Provider Details

I. General information

NPI: 1356542690
Provider Name (Legal Business Name): CHARLES D. WHITE DMD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 ISLAND POND RD
ATKINSON NH
03811-2131
US

IV. Provider business mailing address

29 ISLAND POND RD
ATKINSON NH
03811-2131
US

V. Phone/Fax

Practice location:
  • Phone: 603-362-5582
  • Fax: 603-362-5501
Mailing address:
  • Phone: 603-362-5582
  • Fax: 603-362-5501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1454
License Number StateNH

VIII. Authorized Official

Name: CHARLES D WHITE
Title or Position: DENTIST
Credential: DMD
Phone: 603-362-5582