Provider Demographics
NPI:1104992163
Name:WITTEN, ANDREW L (DMD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:L
Last Name:WITTEN
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 1:223 W ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-4301
Mailing Address - Country:US
Mailing Address - Phone:904-356-0072
Mailing Address - Fax:904-356-2338
Practice Address - Street 1:223 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-4301
Practice Address - Country:US
Practice Address - Phone:904-356-0072
Practice Address - Fax:904-356-2338
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN117291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice