Provider Demographics
NPI:1902248354
Name:WHITE, YESYLLE MARIE (DMD)
Entity Type:Individual
Prefix:
First Name:YESYLLE
Middle Name:MARIE
Last Name:WHITE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 SAGEWOOD PL SW
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-3727
Mailing Address - Country:US
Mailing Address - Phone:256-238-3052
Mailing Address - Fax:
Practice Address - Street 1:230 E 10TH ST
Practice Address - Street 2:ST 106
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5784
Practice Address - Country:US
Practice Address - Phone:256-741-7340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6037122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist