MEDICARE: DR. WHITNEY REBECCA WHITE DMD

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	122300000X	Dentist	060630	NY
2	1223G0001X	General Practice Dentistry	060630	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184125551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WHITNEY REBECCA WHITE DMD

Provider Business Mailing Address
First Line	:	2570 ROUTE 9W STE 10
Second Line	:
City	:	CORNWALL
State	:	NY
Zip	:	12518-1370
Country	:	US
Telephone Number	:	845-220-3100
Fax Number	:	845-534-2940

Provider Business Practice Location Address
First Line	:	140 HAMMOND ST
Second Line	:
City	:	PORT JERVIS
State	:	NY
Zip	:	12771-2607
Country	:	US
Telephone Number	:	845-858-2854
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2018
Last Update Date	:	03/18/2020

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