MEDICARE: WHITE DENTAL LIMITED COMPANY 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	29531	TX
2	261QD0000X	Dental Clinic/Center	29866	TX

General Provider Information

NPI Number	:	1346749231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITE DENTAL LIMITED COMPANY PLLC

Provider Business Mailing Address
First Line	:	3878 OAK LAWN AVENUE SUITE 310
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219
Country	:	US
Telephone Number	:	214-484-1064
Fax Number	:	469-458-6481

Provider Business Practice Location Address
First Line	:	3878 OAK LAWN AVENUE SUITE 310
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219
Country	:	US
Telephone Number	:
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	E-JAN TUNG
Credential	:
Telephone Number	:	214-484-1064

Provider Enumeration Date	:	02/06/2018
Last Update Date	:	02/06/2018

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