Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 10288 | MD |
NPI | 1003046749 |
---|---|
Provider Name | Michael A White |
First Address | Baltimore, MD 21218-3322 |
Second Address | Baltimore, MD 21218-3322 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2009 |
Last Update Date | 22/10/2021 |