Active NPI
Kelly Loy White, DDS
- General Practice Dentistry
- Princeton, WI
National Provider Identifier
1659498673
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- WI3155
- Practice address
- 617 W Water St
Princeton, WI 54968-9144 - Phone
- (920) 295-6350
- NPI assigned
- Mar 23, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | WI3155 | WI | Primary |
Addresses
Primary practice location
617 W Water St
Princeton, WI 54968-9144
Mailing address
169 Memorial Dr
Berlin, WI 54923-1241
Phone (920) 361-3080
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| WI3155 | WI | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174608000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652140800000",
"number": "1659498673",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "169 MEMORIAL DR",
"city": "BERLIN",
"state": "WI",
"postal_code": "549231241",
"telephone_number": "920-361-3080",
"fax_number": "920-361-3054"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "617 W WATER ST",
"city": "PRINCETON",
"state": "WI",
"postal_code": "549689144",
"telephone_number": "920-295-6350"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITE",
"first_name": "KELLY",
"middle_name": "LOY",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-23",
"last_updated": "2022-05-10",
"certification_date": "2022-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WI",
"license": "WI3155",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Princeton, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.