Individual
DR. JOHN EDWARD WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
130 S RAPP AVE, COLUMBIA, IL 62236-2352
(618) 281-7300
(618) 281-8872
Mailing address
130 S RAPP AVE, COLUMBIA, IL 62236-2352
(618) 281-7300
(618) 281-8872
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019-14438
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019-14438
DENTAL LICENSE
IL
Enumeration date
08/24/2006
Last updated
07/08/2007
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