MEDICARE: DR. STUART C. WHITE DDS

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	1223X0008X	Oral and Maxillofacial Radiology Dentistry	D20082	CA

General Provider Information

NPI Number	:	1679580575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STUART C. WHITE DDS

Provider Business Mailing Address
First Line	:	10833 LE CONTE AVE. CHS 10-165
Second Line	:	BOX 951668
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-1668
Country	:	US
Telephone Number	:	310-825-5634
Fax Number	:	310-206-2748

Provider Business Practice Location Address
First Line	:	10833 LE CONTE AVE. CHS 10-165
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-1668
Country	:	US
Telephone Number	:	310-825-5634
Fax Number	:	310-206-2748

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	07/08/2007

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