MEDICARE: DR. JAVONNE MCKOY WHITE D.D.S.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DN012650	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316916919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAVONNE MCKOY WHITE D.D.S.

Provider Business Mailing Address
First Line	:	168 NW BROAD ST
Second Line	:
City	:	FAIRBURN
State	:	GA
Zip	:	30213-1436
Country	:	US
Telephone Number	:	770-964-1545
Fax Number	:	770-964-1031

Provider Business Practice Location Address
First Line	:	168 NW BROAD ST
Second Line	:
City	:	FAIRBURN
State	:	GA
Zip	:	30213-1436
Country	:	US
Telephone Number	:	770-964-1545
Fax Number	:	770-964-1031

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

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	04/16/2014

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Directions to “ DR. JAVONNE MCKOY WHITE D.D.S.” Practice Location

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