Provider Demographics
NPI:1962541813
Name:DEWITT DENTAL ASSOCIATES PC
Entity type:Organization
Organization Name:DEWITT DENTAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:DEWITT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MA
Authorized Official - Phone:303-321-5656
Mailing Address - Street 1:3300 E 1ST AVE
Mailing Address - Street 2:SUITE 615
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5810
Mailing Address - Country:US
Mailing Address - Phone:303-321-5656
Mailing Address - Fax:303-321-5341
Practice Address - Street 1:3300 E 1ST AVE
Practice Address - Street 2:SUITE 615
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5810
Practice Address - Country:US
Practice Address - Phone:303-321-5656
Practice Address - Fax:303-321-5341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO105943126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes126800000XDental ProvidersDental AssistantGroup - Single Specialty