MEDICARE: DR. TREVOR M 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	1223G0001X	General Practice Dentistry	DDS-09574	IA

General Provider Information

NPI Number	:	1871089144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TREVOR M WHITE DDS

Provider Business Mailing Address
First Line	:	974 73RD ST STE 37
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50265-1026
Country	:	US
Telephone Number	:	515-282-0973
Fax Number	:

Provider Business Practice Location Address
First Line	:	974 73RD ST STE 37
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50265-1026
Country	:	US
Telephone Number	:	515-282-0973
Fax Number	:

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

Provider Enumeration Date	:	07/10/2018
Last Update Date	:	07/10/2018

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