MEDICARE: DR. LAUREN C WHITE DDS

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	30.024162	OH

General Provider Information

NPI Number	:	1417397787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAUREN C WHITE DDS

Provider Business Mailing Address
First Line	:	5380 PLEASANT AVE
Second Line	:	SUITE 3B
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-3582
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5380 PLEASANT AVE
Second Line	:	SUITE 3B
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-3582
Country	:	US
Telephone Number	:	513-829-1100
Fax Number	:

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

Provider Enumeration Date	:	07/01/2013
Last Update Date	:	06/25/2014

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