Healthcare Provider Details

I. General information

NPI: 1720362296
Provider Name (Legal Business Name): LONDON-WHITE AND MAGGARD, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2011
Last Update Date: 10/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CITY HILL DR SUITE 101
LONDON KY
40741-3038
US

IV. Provider business mailing address

200 CITY HILL DR SUITE 101
LONDON KY
40741-3038
US

V. Phone/Fax

Practice location:
  • Phone: 606-877-1900
  • Fax: 606-877-1755
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6263
License Number StateKY

VIII. Authorized Official

Name: DR. JAMES GREGORY WHITE
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 859-296-4846