Provider Demographics
NPI:1871703082
Name:WHITE, KINGSLY DIONE (DDS)
Entity type:Individual
Prefix:PROF
First Name:KINGSLY
Middle Name:DIONE
Last Name:WHITE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61438 LINTON LOOP
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3219
Mailing Address - Country:US
Mailing Address - Phone:678-800-3970
Mailing Address - Fax:
Practice Address - Street 1:80 NE BEND RIVER MALL AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-7528
Practice Address - Country:US
Practice Address - Phone:541-647-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD117701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice