Provider Demographics
NPI:1386899789
Name:JOHN B. WITTE, DDS, PC
Entity type:Organization
Organization Name:JOHN B. WITTE, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WITTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-784-1000
Mailing Address - Street 1:3035 MATLOCK RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2902
Mailing Address - Country:US
Mailing Address - Phone:817-784-1000
Mailing Address - Fax:817-465-3632
Practice Address - Street 1:3035 MATLOCK RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2902
Practice Address - Country:US
Practice Address - Phone:817-784-1000
Practice Address - Fax:817-465-3632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX132921223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty