=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720362296
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LONDON-WHITE AND MAGGARD, PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2011
-----------------------------------------------------
Last Update Date | 10/03/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 CITY HILL DR SUITE 101
-----------------------------------------------------
City | LONDON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40741-3038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-877-1900
-----------------------------------------------------
Fax | 606-877-1755
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 CITY HILL DR SUITE 101
-----------------------------------------------------
City | LONDON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40741-3038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JAMES GREGORY WHITE
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 859-296-4846
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 6263
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------