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General NPI Number Information
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NPI Number | 1942524335
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Entity Type | Organization
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Legal Business Name | WHITE MOUNTAIN DENTISTRY
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Dates
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Enumeration Date | 03/15/2010
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Last Update Date | 03/15/2010
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Provider Practice Location Address
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Address Line | 986 S MAIN ST
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City | SNOWFLAKE
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State | AZ
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Zip | 85937-5500
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Country | US
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Telephone | 928-536-5353
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Fax | 928-536-5753
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Provider Business Mailing Address
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Address Line | 986 S MAIN ST
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City | SNOWFLAKE
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State | AZ
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Zip | 85937-5500
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Country | US
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Telephone | 928-536-5353
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Fax | 928-536-5753
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Authorized Official
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Title or Position | OWNER
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Name | MR. BENJAMIN L TENNEY
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Credential |
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Telephone | 928-536-5353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | AZ7350
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License Number State | AZ
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