Individual
MR. DEXTER WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
143 IRON BRIDGE RD, HAVANA, FL 32333-5711
(850) 345-1044
Mailing address
143 IRON BRIDGE RD, HAVANA, FL 32333-5711
(850) 345-1044
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
376J00000X
Homemaker
Primary
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NONE
FL
Enumeration date
10/13/2022
Last updated
10/13/2022
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