Organization
GERALD G. WHITE, DDS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GERALD GRENIER WHITE DDS (PRESIDENT)
(251) 343-8000
Entity
Organization
Contact information
Practice address
6164 OMNI PARK DR, MOBILE, AL 36609-5195
(251) 343-8000
Mailing address
6164 OMNI PARK DR, MOBILE, AL 36609-5195
(251) 343-8000
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4821
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009960150
—
AL
01
—
51075993WHI
BLUE CROSS BLUE SHIELD OF ALABAMA
AL
Enumeration date
06/02/2017
Last updated
07/21/2022
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