Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 5196 | NC |
NPI | 1346918398 |
---|---|
Provider Name | Dr. Benjamin Alexander White JR. |
First Address | Southern Pines, NC 28387-4974 |
Second Address | Southern Pines, NC 28387-4974 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2021 |
Last Update Date | 03/09/2021 |