MEDICARE: R L WHITE JR., DDS & ASSOCIATES, PC

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	DNO12581	GA

General Provider Information

NPI Number	:	1801046297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R L WHITE JR., DDS & ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	168 NW BROAD ST
Second Line	:
City	:	FAIRBURN
State	:	GA
Zip	:	30213-1436
Country	:	US
Telephone Number	:	770-964-1545
Fax Number	:	770-964-1031

Provider Business Practice Location Address
First Line	:	168 NW BROAD ST
Second Line	:
City	:	FAIRBURN
State	:	GA
Zip	:	30213-1436
Country	:	US
Telephone Number	:	770-964-1545
Fax Number	:	770-964-1031

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT LEE WHITE JR.
Credential	:	DDS
Telephone Number	:	770-964-1545

Provider Enumeration Date	:	09/23/2008
Last Update Date	:	09/23/2008

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