MEDICARE: DR. JOHN CRAIG WHITE DDS MSD

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	30-018738	OH

General Provider Information

NPI Number	:	1417005299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN CRAIG WHITE DDS MSD

Provider Business Mailing Address
First Line	:	9365 OLDE 8 RD
Second Line	:
City	:	NORTHFIELD
State	:	OH
Zip	:	44067-2052
Country	:	US
Telephone Number	:	330-468-0607
Fax Number	:	330-468-1329

Provider Business Practice Location Address
First Line	:	9365 OLDE 8 RD
Second Line	:
City	:	NORTHFIELD
State	:	OH
Zip	:	44067-2052
Country	:	US
Telephone Number	:	330-468-0607
Fax Number	:	330-468-1329

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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