MEDICARE: MR. RAYMOND EARL WHITE JR. DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2242	SC

General Provider Information

NPI Number	:	1093819104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAYMOND EARL WHITE JR. DMD

Provider Business Mailing Address
First Line	:	203 S WESTON ST
Second Line	:
City	:	FOUNTAIN INN
State	:	SC
Zip	:	29644-1964
Country	:	US
Telephone Number	:	864-862-4484
Fax Number	:	864-862-7755

Provider Business Practice Location Address
First Line	:	203 S WESTON ST
Second Line	:
City	:	FOUNTAIN INN
State	:	SC
Zip	:	29644-1964
Country	:	US
Telephone Number	:	864-862-4484
Fax Number	:	864-862-7755

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2006
Last Update Date	:	07/08/2007

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