Healthcare Provider Details

I. General information

NPI: 1467191056
Provider Name (Legal Business Name): BETHANY WHITE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5506 WHITESIDE RD
SANDSTON VA
23150-2345
US

IV. Provider business mailing address

3501 MIDDLEWICH WAY
HENRICO VA
23231-2403
US

V. Phone/Fax

Practice location:
  • Phone: 804-322-3669
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0401418760
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: