1720362296 NPI number — LONDON-WHITE AND MAGGARD, PSC

Table of content: (NPI 1720362296)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720362296 NPI number — LONDON-WHITE AND MAGGARD, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LONDON-WHITE AND MAGGARD, PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WHITE AND MAGGARD ORTHODONTICS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720362296
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 CITY HILL DR
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
LONDON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40741-3038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 CITY HILL DR
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
LONDON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40741-3038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-877-1900
Provider Business Practice Location Address Fax Number:
606-877-1755
Provider Enumeration Date:
10/03/2011

Additional Information

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
GREGORY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
859-296-4846

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  6263 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com