Healthcare Provider Details

I. General information

NPI: 1144759275
Provider Name (Legal Business Name): WHITE SMILES FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

594 E 800 S SUITE G
OREM UT
84097
US

IV. Provider business mailing address

594 E 800 S STE G
OREM UT
84097-6303
US

V. Phone/Fax

Practice location:
  • Phone: 801-765-1443
  • Fax: 801-722-0045
Mailing address:
  • Phone: 801-765-1443
  • Fax: 801-722-0045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JEREMY J WHITE
Title or Position: PRACTICE OWNER
Credential: DDS
Phone: 801-765-1443