MEDICARE: DR. BENJAMIN DONTREAL WHITE RD

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	133VN1004X	Pediatric Nutrition Registered Dietitian	DT88823	TX

General Provider Information

NPI Number	:	1972480358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN DONTREAL WHITE RD

Provider Business Mailing Address
First Line	:	2900 N BRAESWOOD BLVD APT 1314
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-2368
Country	:	US
Telephone Number	:	346-719-0271
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 N BRAESWOOD BLVD APT 1314
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-2368
Country	:	US
Telephone Number	:	346-719-0271
Fax Number	:

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

Provider Enumeration Date	:	08/19/2025
Last Update Date	:	08/19/2025

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