Provider Demographics
NPI:1881714764
Name:WHITE, ROBERT CECIL JR (DMD MS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CECIL
Last Name:WHITE
Suffix:JR
Gender:M
Credentials:DMD MS
Other - Prefix:
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Mailing Address - Street 1:914 MEDALLION DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-2118
Mailing Address - Country:US
Mailing Address - Phone:662-453-4545
Mailing Address - Fax:662-453-2142
Practice Address - Street 1:914 MEDALLION DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-2118
Practice Address - Country:US
Practice Address - Phone:662-453-4545
Practice Address - Fax:662-453-2142
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS1955-81 OR-76-831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics