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General NPI Number Information
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NPI Number | 1801046297
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Entity Type | Organization
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Legal Business Name | R L WHITE JR., DDS & ASSOCIATES, PC
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Dates
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Enumeration Date | 09/23/2008
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Last Update Date | 09/23/2008
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Provider Practice Location Address
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Address Line | 168 NW BROAD ST
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City | FAIRBURN
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State | GA
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Zip | 30213-1436
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Country | US
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Telephone | 770-964-1545
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Fax | 770-964-1031
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Provider Business Mailing Address
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Address Line | 168 NW BROAD ST
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City | FAIRBURN
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State | GA
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Zip | 30213-1436
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Country | US
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Telephone | 770-964-1545
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Fax | 770-964-1031
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT LEE WHITE JR.
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Credential | DDS
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Telephone | 770-964-1545
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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 | DNO12581
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License Number State | GA
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