Provider Demographics
NPI:1487885794
Name:WHITE, CARL LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:LEE
Last Name:WHITE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 VENTURE DR # 163
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-7306
Mailing Address - Country:US
Mailing Address - Phone:304-282-9622
Mailing Address - Fax:
Practice Address - Street 1:714 VENTURE DR # 163
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-7306
Practice Address - Country:US
Practice Address - Phone:304-282-9622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2012-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV37991223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics