Provider Demographics
NPI:1326171109
Name:WITT ORTHODONTICS PC
Entity type:Organization
Organization Name:WITT ORTHODONTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MSD
Authorized Official - Phone:508-829-7650
Mailing Address - Street 1:1406 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-1090
Mailing Address - Country:US
Mailing Address - Phone:508-829-7650
Mailing Address - Fax:508-829-4616
Practice Address - Street 1:1406 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520-1090
Practice Address - Country:US
Practice Address - Phone:508-829-7650
Practice Address - Fax:508-829-4616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA179001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty