Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 011711 | MO |
NPI | 1063475333 |
---|---|
Provider Name | Mr. Robert H White |
First Address | Kansas City, MO 64113-2224 |
Second Address | Kansas City, MO 64113-2224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2006 |
Last Update Date | 08/07/2007 |