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General NPI Number Information
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NPI Number | 1528469020
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Entity Type | Individual
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Provider Name | FELICIA SHANAHAN-WHITE DMD
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Gender | Female
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Dates
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Enumeration Date | 09/16/2014
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Last Update Date | 08/23/2023
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Provider Practice Location Address
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Address Line | 142 MAYO CIR STE 100
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City | PIKEVILLE
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State | KY
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Zip | 41501-1831
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Country | US
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Telephone | 606-432-0187
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Fax |
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Provider Business Mailing Address
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Address Line | 142 MAYO CIR STE 100
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City | PIKEVILLE
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State | KY
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Zip | 41501-1831
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN.00202365
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401416995
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10194
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License Number State | KY
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