Healthcare Provider Details

I. General information

NPI: 1174746002
Provider Name (Legal Business Name): HARRY L. WHITE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23800 ALISO CREEK RD
LAGUNA NIGUEL CA
92677-3930
US

IV. Provider business mailing address

3 CRYSTAL VIEW RDG
LAGUNA NIGUEL CA
92677-7958
US

V. Phone/Fax

Practice location:
  • Phone: 949-831-5500
  • Fax: 949-448-7795
Mailing address:
  • Phone: 949-363-7520
  • Fax: 949-363-1829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDX25307
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: