Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 2767 | SC |
NPI | 1497820880 |
---|---|
Provider Name | Dr. David B White |
First Address | Surfside Beach, SC 29575 |
Second Address | Surfside Beach, SC 29575 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 08/07/2007 |