Individual
DOUGLAS JACK WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
110 E FAYETTE ST, PITTSFIELD, IL 62363-1949
(217) 285-5553
Mailing address
110 E FAYETTE ST, P.O. BOX 288, PITTSFIELD, IL 62363-1949
(217) 285-5553
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
IL
Other
Enumeration date
04/26/2007
Last updated
07/08/2007
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