Provider Demographics
NPI:1487966198
Name:WHITE, DUSTIN CHRISTOPHER (DDS)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:CHRISTOPHER
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 1:1901 HIGHWAY 190
Mailing Address - Street 2:APT 1123
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-3470
Mailing Address - Country:US
Mailing Address - Phone:651-270-1614
Mailing Address - Fax:
Practice Address - Street 1:281 W 4TH ST
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:LA
Practice Address - Zip Code:70443-2386
Practice Address - Country:US
Practice Address - Phone:985-878-0066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA60931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice