Organization
BRILLIANT WHITE DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FREDRIC J. WHITE DDS (OWNER)
(520) 730-8388
Entity
Organization
Contact information
Practice address
2151 S HIGHWAY 92 STE 109, SIERRA VISTA, AZ 85635-5283
(520) 730-8388
Mailing address
2151 S HIGHWAY 92 STE 109, SIERRA VISTA, AZ 85635-5283
(520) 730-8388
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
01/17/2023
Last updated
07/17/2023
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