Provider Demographics
NPI:1528063831
Name:GARY L. WHITE, D.D.S., P.A.
Entity type:Organization
Organization Name:GARY L. WHITE, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-731-2124
Mailing Address - Street 1:3701 HULEN ST
Mailing Address - Street 2:STE A
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-6870
Mailing Address - Country:US
Mailing Address - Phone:817-731-2124
Mailing Address - Fax:817-731-6770
Practice Address - Street 1:3701 HULEN ST
Practice Address - Street 2:STE A
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6870
Practice Address - Country:US
Practice Address - Phone:817-731-2124
Practice Address - Fax:817-731-6770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty