1255499869 NPI number — SONYA F WHITE DDS

Table of content: SONYA F WHITE DDS (NPI 1255499869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255499869 NPI number — SONYA F WHITE DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITE
Provider First Name:
SONYA
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WHITE
Provider Other First Name:
SONYA
Provider Other Middle Name:
F
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.D.S.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1255499869
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6309 PICCADILLY SQUARE DRIVE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36695
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-341-1500
Provider Business Mailing Address Fax Number:
251-341-1400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6309 PICCADILLY SQUARE DRIVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36695
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-341-1500
Provider Business Practice Location Address Fax Number:
251-341-1400
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  LNO4966 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 04727349 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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