| Name: | Gerald G. White, D.D.S., P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 07 Oct 1997 (27 years ago) |
| Entity Number: | 000-190-731 |
| Register Number: | 000190731 |
| County: | Mobile |
| Place of Formation: | Mobile County |
| Registered Office Street Address: | 6343-D AIRPORT BLVD, STE 2MOBILE, AL 36608 |
| Registered Office Street Address ZIP Code: | 36608 |
| Authorized Capital: | $1,000 |
Activities
DENTISTRY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1104354232 | 2017-06-02 | 2022-07-21 | 6164 OMNI PARK DR, MOBILE, AL, 366095195, US | 6164 OMNI PARK DR, MOBILE, AL, 366095195, US | |||||||||||||||||||||||||||||
|
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| Phone | +1 251-343-8000 |
Authorized person
| Name | DR. GERALD GRENIER WHITE |
| Role | PRESIDENT |
| Phone | 2513438000 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | 4821 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD OF ALABAMA |
| Number | 51075993WHI |
| State | AL |
| Issuer | MEDICAID |
| Number | 009960150 |
| State | AL |
| Name | Role |
|---|---|
| WHITE, GERALD G | Agent |
| Name | Role |
|---|---|
| WHITE, GERALD G | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
