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General NPI Number Information
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NPI Number | 1871289918
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Entity Type | Individual
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Provider Name | CHRISTIANA MICA WHITE DMD
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Gender | Female
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Dates
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Enumeration Date | 04/12/2023
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Last Update Date | 01/20/2026
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Provider Practice Location Address
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Address Line | 708 DALLAS ST
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City | CHETEK
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State | WI
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Zip | 54728-9120
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Country | US
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Telephone | 715-924-4841
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Fax |
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Provider Business Mailing Address
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Address Line | 2424 TULANE AVE APT 706
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City | NEW ORLEANS
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State | LA
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Zip | 70119-7570
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Country | US
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Telephone | 904-891-1085
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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 | 6001721-15
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License Number State | WI
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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 | 7603
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License Number State | LA
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