MEDICARE: DR. JAMIE ROBIN WHITE 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	D8160	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	027915	OTHER	OR	OMAP

General Provider Information

NPI Number	:	1437230521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMIE ROBIN WHITE DMD

Provider Business Mailing Address
First Line	:	205 N PHOENIX RD # 410
Second Line	:
City	:	PHOENIX
State	:	OR
Zip	:	97535-9104
Country	:	US
Telephone Number	:	541-535-4142
Fax Number	:	541-535-3415

Provider Business Practice Location Address
First Line	:	205 N PHOENIX RD STE 410
Second Line	:
City	:	PHOENIX
State	:	OR
Zip	:	97535-9104
Country	:	US
Telephone Number	:	541-535-4142
Fax Number	:	541-535-3415

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	11/02/2023

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