Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | AR2675 | AR |
NPI | 1154496297 |
---|---|
Provider Name | Dr. Charles Adrian White |
First Address | Rogers, AR 72756 |
Second Address | Rogers, AR 72756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2006 |
Last Update Date | 08/07/2007 |