Healthcare Provider Details

I. General information

NPI: 1568108496
Provider Name (Legal Business Name): WHITE SPRUCE SMILES DENTAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2024 W HENRIETTA RD STE 1A
ROCHESTER NY
14623-1356
US

IV. Provider business mailing address

329 S MAIN ST
CANANDAIGUA NY
14424-2118
US

V. Phone/Fax

Practice location:
  • Phone: 585-919-6624
  • Fax:
Mailing address:
  • Phone: 585-919-6624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER A MORELLO
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 585-919-6624