MEDICARE: GENEVA WHITE DMD PA

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	DN12984	FL

General Provider Information

NPI Number	:	1710319884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENEVA WHITE DMD PA

Provider Business Mailing Address
First Line	:	5970 S JOG RD STE E
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-6576
Country	:	US
Telephone Number	:	561-434-4344
Fax Number	:	561-434-3634

Provider Business Practice Location Address
First Line	:	5970 S JOG RD STE E
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-6576
Country	:	US
Telephone Number	:	561-434-4344
Fax Number	:	561-434-3634

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. GENEVA WHITE
Credential	:	DMD
Telephone Number	:	561-434-4344

Provider Enumeration Date	:	07/31/2013
Last Update Date	:	07/31/2013

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