Provider Demographics
NPI:1669603718
Name:WHITE, SHAUN TRAVIS (DMD)
Entity type:Individual
Prefix:
First Name:SHAUN
Middle Name:TRAVIS
Last Name:WHITE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 WAYNE MEMORIAL DR STE C
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-2269
Mailing Address - Country:US
Mailing Address - Phone:919-581-0909
Mailing Address - Fax:833-780-5944
Practice Address - Street 1:1310 WAYNE MEMORIAL DR STE C
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-2269
Practice Address - Country:US
Practice Address - Phone:919-581-0909
Practice Address - Fax:833-780-5944
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice