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Individual

DR. CLARICE RENA WHITE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
DDS

Contact information

Practice address
12173 MAIN ST STE B, MASON, TN 38049-7054
(901) 294-2634
(901) 294-2639
Mailing address
12173 MAIN ST, SUITE B, MASON, TN 38049-7054
(901) 294-2634
(901) 294-2639

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS0000005088
TN
246RM2200X
Medical Laboratory Technician
ML0000008122
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3205221
TN
05
3225798
TN
01
4098095
BLUECROSS BLUESHIELD
TN
01
4777
DORAL DENTAL
TN
01
DS005088
LICENSE
TN
Enumeration date
11/08/2005
Last updated
06/14/2017
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