Healthcare Provider Details

I. General information

NPI: 1154764793
Provider Name (Legal Business Name): GREGORY DANIEL WHITE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2013
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6599 MAIN ST
WILLIAMSVILLE NY
14221-5820
US

IV. Provider business mailing address

80 ROLLINGWOOD ST
WILLIAMSVILLE NY
14221-1834
US

V. Phone/Fax

Practice location:
  • Phone: 716-333-7873
  • Fax:
Mailing address:
  • Phone: 716-903-3274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number059138
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: