Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2901008632 | MI |
NPI | 1003822685 |
---|---|
Provider Name | Dr. Melvin Alan White |
First Address | Battle Creek, MI 49037-2963 |
Second Address | Battle Creek, MI 49037-2963 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 06/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4500679 | (05) | MI |
4592680 | (05) | MI |