MEDICARE: DR. JASON KILLIAN WITTENMYER DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DCT5	FL
2	1223G0001X	General Practice Dentistry	8022	KY

General Provider Information

NPI Number	:	1205125796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON KILLIAN WITTENMYER DMD

Provider Business Mailing Address
First Line	:	1540 CHADWICK WAY
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-3774
Country	:	US
Telephone Number	:	502-617-9155
Fax Number	:

Provider Business Practice Location Address
First Line	:	1540 CHADWICK WAY
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-3774
Country	:	US
Telephone Number	:	850-617-9155
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2011
Last Update Date	:	12/08/2025

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