MEDICARE: JEFFREY S WITTMUS DDS LTD

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	1223D0001X	Public Health Dentistry

General Provider Information

NPI Number	:	1841785375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFREY S WITTMUS DDS LTD

Provider Business Mailing Address
First Line	:	5315 N CENTRAL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-1302
Country	:	US
Telephone Number	:	773-631-6060
Fax Number	:

Provider Business Practice Location Address
First Line	:	5315 N CENTRAL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-1302
Country	:	US
Telephone Number	:	773-631-6060
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JEFFREY WITTMUS
Credential	:
Telephone Number	:	773-631-1624

Provider Enumeration Date	:	06/27/2018
Last Update Date	:	06/27/2018

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