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General NPI Number Information
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NPI Number | 1275136426
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Entity Type | Organization
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Legal Business Name | WHITE TEETH DENTAL, PLLC
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Dates
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Enumeration Date | 11/19/2020
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Last Update Date | 11/19/2020
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Provider Practice Location Address
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Address Line | 206 S LOOP 336 W # D
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City | CONROE
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State | TX
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Zip | 77304-3300
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Country | US
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Telephone | 936-760-1737
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Fax | 936-340-9072
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Provider Business Mailing Address
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Address Line | 206 S LOOP 336 W # D
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City | CONROE
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State | TX
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Zip | 77304-3300
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Country | US
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Telephone | 936-760-1737
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Fax | 936-340-9072
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. CAROL WHITE
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Credential | DDS
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Telephone | 936-760-1737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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