Provider Demographics
NPI:1417767922
Name:DAVID D WITSCHEN D.D.S. PA
Entity type:Organization
Organization Name:DAVID D WITSCHEN D.D.S. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:WITSCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-741-5070
Mailing Address - Street 1:710 9TH ST N
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-2322
Mailing Address - Country:US
Mailing Address - Phone:218-741-5070
Mailing Address - Fax:218-293-6002
Practice Address - Street 1:710 9TH ST N
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-2322
Practice Address - Country:US
Practice Address - Phone:218-741-5070
Practice Address - Fax:218-293-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty