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General NPI Number Information
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NPI Number | 1619290905
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Entity Type | Individual
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Provider Name | FADRA M WHYTE DMD
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Gender | Female
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Dates
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Enumeration Date | 03/01/2010
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Last Update Date | 08/03/2016
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Provider Practice Location Address
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Address Line | 8110 BIRMINGHAM WAY
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City | SAN DIEGO
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State | CA
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Zip | 92123
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Country | US
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Telephone | 619-662-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 3845 KENDALL ST APT D
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City | SAN DIEGO
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State | CA
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Zip | 92109-6500
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Country | US
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Telephone | 412-956-3485
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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 | 62096
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | #390200000X
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 22DI02439000
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License Number State | NJ
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