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NPI Code Detail

MEDICARE: DR. LARRY DOUGLAS WHITE D.D.S.

MEDICARE:  DR. LARRY DOUGLAS 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
11223G0001XGeneral Practice Dentistry13290TX

General Provider Information

NPI Number : 1912915075
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LARRY DOUGLAS WHITE D.D.S.
Provider Business Mailing Address
First Line : 606 JENNY GAYE LN
Second Line :
City : HIGHLANDS
State : TX
Zip : 77562-2708
Country : US
Telephone Number : 281-426-5352
Fax Number :
Provider Business Practice Location Address
First Line : 114 N MAIN ST
Second Line :
City : HIGHLANDS
State : TX
Zip : 77562-3806
Country : US
Telephone Number : 281-426-3558
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2006
Last Update Date : 07/08/2007

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Directions to “ DR. LARRY DOUGLAS WHITE D.D.S.” Practice Location

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