MEDICARE: DR. MICHELE SUSAN 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	1223G0001X	General Practice Dentistry	19158	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	117867	OTHER	TX	DENTAL BENEFIT PROVIDER
2	19158	OTHER	TX	LICENSE #
3	B1915801	OTHER	TX	TEXAS CHIP
4	D284806	OTHER	TX	CIGNA INS.
5	553022	OTHER	TX	UNITED CONCORDIA

General Provider Information

NPI Number	:	1639218555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELE SUSAN WHITE D.D.S

Provider Business Mailing Address
First Line	:	7338 MCHENRY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77087-3633
Country	:	US
Telephone Number	:	713-649-3020
Fax Number	:	713-649-3020

Provider Business Practice Location Address
First Line	:	7338 MCHENRY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77087-3633
Country	:	US
Telephone Number	:	713-649-3020
Fax Number	:	713-649-3020

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. MICHELE SUSAN WHITE D.D.S” Practice Location

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