Provider Demographics
NPI:1962616573
Name:DEWITT, ROBERT H (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:H
Last Name:DEWITT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8310 OLD COURTHOUSE RD STE B
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3872
Mailing Address - Country:US
Mailing Address - Phone:703-734-5707
Mailing Address - Fax:703-734-5708
Practice Address - Street 1:8310 OLD COURTHOUSE RD STE B
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3872
Practice Address - Country:US
Practice Address - Phone:703-734-5707
Practice Address - Fax:703-734-5708
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006524122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist