Provider Demographics
NPI:1528086667
Name:WHITE, ELIZABETH S (DMD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:S
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 1:102 METRO DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-1985
Mailing Address - Country:US
Mailing Address - Phone:334-792-1962
Mailing Address - Fax:334-792-3637
Practice Address - Street 1:102 METRO DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-1985
Practice Address - Country:US
Practice Address - Phone:334-792-1962
Practice Address - Fax:334-792-3637
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL42031223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL00830574OtherUNITED CONCORDIA PROVIDER
AL91755OtherBC/BS OF AL PROVIDER