1023230489 NPI number — DR. RON S WHITE DDS

Table of content: DR. RON S WHITE DDS (NPI 1023230489)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023230489 NPI number — DR. RON S WHITE DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITE
Provider First Name:
RON
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1023230489
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4189 EAST HWY 290
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DRIPPING SPRINGS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-501-3839
Provider Business Mailing Address Fax Number:
888-854-6676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14101 WEST HWY 290 SUITE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-894-4777
Provider Business Practice Location Address Fax Number:
512-894-3426
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  18730 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 18730 . This is a "TEXAS STATE LICENSE NUMBE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 470955437 . This is a "TAX IDENTIFICATION NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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