Healthcare Provider Details

I. General information

NPI: 1417005299
Provider Name (Legal Business Name): JOHN CRAIG WHITE DDS MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9365 OLDE 8 RD
NORTHFIELD OH
44067-2052
US

IV. Provider business mailing address

9365 OLDE 8 RD
NORTHFIELD OH
44067-2052
US

V. Phone/Fax

Practice location:
  • Phone: 330-468-0607
  • Fax: 330-468-1329
Mailing address:
  • Phone: 330-468-0607
  • Fax: 330-468-1329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number30-018738
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: