Healthcare Provider Details

I. General information

NPI: 1265027304
Provider Name (Legal Business Name): JAMIE R WHITE DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N PHOENIX RD STE 410
PHOENIX OR
97535-9104
US

IV. Provider business mailing address

205 N PHOENIX RD STE 410
PHOENIX OR
97535-9104
US

V. Phone/Fax

Practice location:
  • Phone: 541-535-4142
  • Fax: 541-535-3415
Mailing address:
  • Phone: 541-535-4142
  • Fax: 541-535-3415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1437230521
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerNPI

VIII. Authorized Official

Name: JAMIE WHITE
Title or Position: OWNER/GENERAL DENTIST
Credential: DMD
Phone: 541-535-4142