Provider Demographics
NPI:1861557100
Name:WHITE, GARY ALAN (DMD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:ALAN
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 1:3621 NW 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-7531
Mailing Address - Country:US
Mailing Address - Phone:360-834-6406
Mailing Address - Fax:
Practice Address - Street 1:320 NE 5TH ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7308
Practice Address - Country:US
Practice Address - Phone:503-666-5484
Practice Address - Fax:503-661-1069
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD87871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice