Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DS021317L | PA |
NPI | 1013031244 |
---|---|
Provider Name | Tommy Bernard White |
First Address | Camp Pendleton, CA 92055 |
Second Address | Camp Pendleton, CA 92055 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2007 |
Last Update Date | 08/07/2007 |