Healthcare Provider Details

I. General information

NPI: 1942749718
Provider Name (Legal Business Name): JORDAN RANSOME WHITE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2017
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3607 DAVIS DR STE 209
MORRISVILLE NC
27560-6005
US

IV. Provider business mailing address

1595 VAUGHAN CREEK RD
PENDLETON NC
27862-7081
US

V. Phone/Fax

Practice location:
  • Phone: 919-469-2122
  • Fax:
Mailing address:
  • Phone: 252-578-8299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10665
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: