MEDICARE: ROBIN E. WHITE D.D.S. PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	4642	OK

General Provider Information

NPI Number	:	1164745964
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBIN E. WHITE D.D.S. PLLC

Provider Business Mailing Address
First Line	:	1705 W ELM ST
Second Line	:
City	:	EL RENO
State	:	OK
Zip	:	73036-4203
Country	:	US
Telephone Number	:	405-262-2289
Fax Number	:	405-262-2292

Provider Business Practice Location Address
First Line	:	1705 W ELM ST
Second Line	:
City	:	EL RENO
State	:	OK
Zip	:	73036-4203
Country	:	US
Telephone Number	:	405-262-2289
Fax Number	:	405-262-2292

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBIN E. WHITE
Credential	:	D.D.S.
Telephone Number	:	405-262-2289

Provider Enumeration Date	:	03/08/2010
Last Update Date	:	03/08/2010

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