MEDICARE: CECILIA AMARANTHA 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	1223G0001X	General Practice Dentistry	22DI02726100	NJ

General Provider Information

NPI Number	:	1528611944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CECILIA AMARANTHA WHITE DMD

Provider Business Mailing Address
First Line	:	601 EWING ST STE B16
Second Line	:
City	:	PRINCETON
State	:	NJ
Zip	:	08540-2755
Country	:	US
Telephone Number	:	609-921-0034
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 EWING ST STE B16
Second Line	:
City	:	PRINCETON
State	:	NJ
Zip	:	08540-2755
Country	:	US
Telephone Number	:	609-921-0034
Fax Number	:

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

Provider Enumeration Date	:	07/24/2019
Last Update Date	:	07/24/2019

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