Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 0401006750 | VA |
NPI | 1023202942 |
---|---|
Provider Name | Dr. Terryl A. White |
First Address | Sterling, VA 20165-6154 |
Second Address | Sterling, VA 20165-6154 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2007 |
Last Update Date | 04/09/2007 |