Provider Demographics
NPI:1720130172
Name:BRUCE WHITE DDS P.C.
Entity type:Organization
Organization Name:BRUCE WHITE DDS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-264-8511
Mailing Address - Street 1:1222 E MISSOURI AVE
Mailing Address - Street 2:#201
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2922
Mailing Address - Country:US
Mailing Address - Phone:602-264-8511
Mailing Address - Fax:602-264-3138
Practice Address - Street 1:1222 E MISSOURI AVE
Practice Address - Street 2:#201
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2922
Practice Address - Country:US
Practice Address - Phone:602-264-8511
Practice Address - Fax:602-264-3138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty