Provider Demographics
NPI:1043725807
Name:WHITE, TYLER ROSS (LAC DOM)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:ROSS
Last Name:WHITE
Suffix:
Gender:M
Credentials:LAC DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 FAIRFAX AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-3265
Mailing Address - Country:US
Mailing Address - Phone:304-922-0451
Mailing Address - Fax:
Practice Address - Street 1:33 ORANGE ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2328
Practice Address - Country:US
Practice Address - Phone:304-922-0451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-02
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006131-1171100000X
NC1055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist