Healthcare Provider Details

I. General information

NPI: 1114831476
Provider Name (Legal Business Name): MATTHEW WITTRIG, DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 E COUNTY LINE RD STE C
GREENWOOD IN
46143-1078
US

IV. Provider business mailing address

33 E COUNTY LINE RD STE C
GREENWOOD IN
46143-1078
US

V. Phone/Fax

Practice location:
  • Phone: 317-882-4028
  • Fax:
Mailing address:
  • Phone: 317-882-4028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: KELLI HOLMAN
Title or Position: RDO
Credential:
Phone: 812-764-0148