Healthcare Provider Details

I. General information

NPI: 1730223231
Provider Name (Legal Business Name): LORETTA RENEE WHITE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 EAST 63 STREET
KANSAS CITY MI
64113-2224
US

IV. Provider business mailing address

3613 WEST 122 STREET
LEAWOOD KS
66209-2109
US

V. Phone/Fax

Practice location:
  • Phone: 816-523-2343
  • Fax: 816-523-7210
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: