Healthcare Provider Details

I. General information

NPI: 1346521275
Provider Name (Legal Business Name): JOHNATHAN R. WHITE DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8084 W SAHARA AVE SUITE G
LAS VEGAS NV
89117-2073
US

IV. Provider business mailing address

8084 W SAHARA AVE SUITE G
LAS VEGAS NV
89117-2073
US

V. Phone/Fax

Practice location:
  • Phone: 702-823-3000
  • Fax: 702-685-8254
Mailing address:
  • Phone: 702-823-3000
  • Fax: 702-685-8254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5556
License Number StateNV

VIII. Authorized Official

Name: DR. JOHNATHAN R WHITE
Title or Position: OWNER
Credential: DDS
Phone: 702-823-3000