MEDICARE: WHITE PINE DENTAL HEALTH, PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1144969510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITE PINE DENTAL HEALTH, PLLC

Provider Business Mailing Address
First Line	:	187 MAIN ST
Second Line	:
City	:	BELLEVILLE
State	:	MI
Zip	:	48111-2737
Country	:	US
Telephone Number	:	734-252-6002
Fax Number	:

Provider Business Practice Location Address
First Line	:	187 MAIN ST
Second Line	:
City	:	BELLEVILLE
State	:	MI
Zip	:	48111-2737
Country	:	US
Telephone Number	:	734-252-6002
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. DEANGELO S WEBSTER
Credential	:	DDS
Telephone Number	:	734-395-4146

Provider Enumeration Date	:	06/02/2022
Last Update Date	:	06/02/2022

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