# JASPER PEDIATRIC DENTISTRY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649303355
- **Authorized official:** DR. KATRINA CAROL WHITE DMD (OWNER)
- **Authorized official phone:** (205) 384-9104

## Contact information

- **Practice address:** 4330 HIGHWAY 78 E, SUITE 121, JASPER, AL 35501-8905
- **Practice address phone:** (205) 384-9104
- **Practice address fax:** (205) 384-9102
- **Mailing address:** 4330 HIGHWAY 78 E, SUITE 121, JASPER, AL 35501-8905
- **Mailing address phone:** (205) 384-9104
- **Mailing address fax:** (205) 384-9102

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | 4967 | AL | Yes |

## Other

- **Enumeration date:** 03/13/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 51506630 | BLUE CROSS | AL |