Healthcare Provider Details

I. General information

NPI: 1669603718
Provider Name (Legal Business Name): SHAUN TRAVIS WHITE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 WAYNE MEMORIAL DR STE C
GOLDSBORO NC
27534-2269
US

IV. Provider business mailing address

1310 WAYNE MEMORIAL DR STE C
GOLDSBORO NC
27534-2269
US

V. Phone/Fax

Practice location:
  • Phone: 919-581-0909
  • Fax: 833-780-5944
Mailing address:
  • Phone: 919-581-0909
  • Fax: 833-780-5944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10160
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: