Healthcare Provider Details

I. General information

NPI: 1124119086
Provider Name (Legal Business Name): SALLY ANN WOITOWITZ RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SALLY ANN SCOLLO RDH

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 MAIN ST
MIDDLETOWN CT
06457-2718
US

IV. Provider business mailing address

635 MAIN ST ATTN: CREDENTIALING DEPARTMENT
MIDDLETOWN CT
06457-2718
US

V. Phone/Fax

Practice location:
  • Phone: 860-347-6971
  • Fax: 860-347-4429
Mailing address:
  • Phone: 860-347-6971
  • Fax: 860-638-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number005020
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: