=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902995160
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID MATTHEW WHITE DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3575 GRANT DR STE 1
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89509-5320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-825-4070
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 900 S MEADOWS PKWY APT 411
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89521-5953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-287-7960
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 4567
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------