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General NPI Number Information
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NPI Number | 1902790348
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Entity Type | Organization
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Legal Business Name | CEDAR PEARL DENTAL, LLC
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Dates
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Enumeration Date | 06/09/2025
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 222 CEDAR AVE
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City | CRESTVIEW
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State | FL
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Zip | 32536-2706
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Country | US
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Telephone | 850-682-2720
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Fax |
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Provider Business Mailing Address
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Address Line | 114 WEDGEWOOD CT
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City | CRESTVIEW
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State | FL
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Zip | 32536-8405
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Country | US
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Telephone | 316-323-8745
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. DANIEL S WHITE
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Credential | DMD
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Telephone | 316-323-8745
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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