MEDICARE: DR. LAWRENCE JAY 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	1223G0001X	General Practice Dentistry	22DI01374300	NJ
2	1223G0001X	General Practice Dentistry	036682	NY

General Provider Information

NPI Number	:	1821279662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE JAY WHITE DDS

Provider Business Mailing Address
First Line	:	1 HORIZON RD APT 415
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6506
Country	:	US
Telephone Number	:	201-663-1137
Fax Number	:

Provider Business Practice Location Address
First Line	:	1565 PALISADE AVE
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6911
Country	:	US
Telephone Number	:	201-461-0003
Fax Number	:

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

Provider Enumeration Date	:	11/20/2007
Last Update Date	:	05/20/2026

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