Provider Demographics
NPI:1487698528
Name:WHITE, CECIL JR (DMD)
Entity type:Individual
Prefix:DR
First Name:CECIL
Middle Name:
Last Name:WHITE
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:CECIL
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:2080 CHILD ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32214-5005
Mailing Address - Country:US
Mailing Address - Phone:904-270-4467
Mailing Address - Fax:904-270-4478
Practice Address - Street 1:2080 CHILD ST
Practice Address - Street 2:2080 CHILD STREET
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32214-5005
Practice Address - Country:US
Practice Address - Phone:904-270-4467
Practice Address - Fax:904-270-4478
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 90201223P0300X
VA04010084011223P0300X
IN12009165A1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics