Organization
JASPER PEDIATRIC DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KATRINA CAROL WHITE DMD (OWNER)
(205) 384-9104
Entity
Organization
Contact information
Practice address
4330 HIGHWAY 78 E, SUITE 121, JASPER, AL 35501-8905
(205) 384-9104
(205) 384-9102
Mailing address
4330 HIGHWAY 78 E, SUITE 121, JASPER, AL 35501-8905
(205) 384-9104
(205) 384-9102
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
4967
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51506630
BLUE CROSS
AL
Enumeration date
03/13/2007
Last updated
08/22/2020
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