MEDICARE: DR. JORDAN RANSOME 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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223G0001X	General Practice Dentistry	10665	NC

General Provider Information

NPI Number	:	1942749718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORDAN RANSOME WHITE DMD

Provider Business Mailing Address
First Line	:	1595 VAUGHAN CREEK RD
Second Line	:
City	:	PENDLETON
State	:	NC
Zip	:	27862-7081
Country	:	US
Telephone Number	:	252-578-8299
Fax Number	:

Provider Business Practice Location Address
First Line	:	3607 DAVIS DR STE 209
Second Line	:
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-6005
Country	:	US
Telephone Number	:	919-469-2122
Fax Number	:

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

Provider Enumeration Date	:	02/14/2017
Last Update Date	:	08/14/2019

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