Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | IL |
NPI | 1063532158 |
---|---|
Provider Name | Dr. Velton Curtis White |
First Address | Burlington, WI 53105-2905 |
Second Address | Elgin, IL 60123-5879 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2007 |
Last Update Date | 08/07/2007 |