Provider Demographics
NPI:1528716388
Name:WHITE, DANIEL SHAYNE (DMD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:SHAYNE
Last Name:WHITE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 EAST CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-2706
Mailing Address - Country:US
Mailing Address - Phone:850-682-2720
Mailing Address - Fax:
Practice Address - Street 1:222 EAST CEDAR AVE
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-2706
Practice Address - Country:US
Practice Address - Phone:850-682-2720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-11
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2230421223G0001X
FLDN279841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice