=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437210077
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRESA C. WHITE DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2006
-----------------------------------------------------
Last Update Date | 02/06/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 440 E 18TH ST
-----------------------------------------------------
City | HOPKINSVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42240-3676
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-886-0581
-----------------------------------------------------
Fax | 270-886-2547
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 440 EAST 18TH STREET P.O. BOX 1001
-----------------------------------------------------
City | HOPKINSVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42241-1001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-886-0581
-----------------------------------------------------
Fax | 270-886-2547
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 5858
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 5858
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------