MEDICARE: DR. WILLIAM BECKWITH WHITE D.D.S.

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	21345	CA

General Provider Information

NPI Number	:	1366483513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM BECKWITH WHITE D.D.S.

Provider Business Mailing Address
First Line	:	2015 N WATERMAN AVE
Second Line	:	SUITE #A
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-4834
Country	:	US
Telephone Number	:	909-881-1726
Fax Number	:

Provider Business Practice Location Address
First Line	:	2015 N WATERMAN AVE
Second Line	:	SUITE #A
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-4834
Country	:	US
Telephone Number	:	909-881-1726
Fax Number	:

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	07/08/2007

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