Healthcare Provider Details

I. General information

NPI: 1619952546
Provider Name (Legal Business Name): MICHAEL BITTRICH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 ROUTE 134
SOUTH DENNIS MA
02660-2575
US

IV. Provider business mailing address

900 ROUTE 134
SOUTH DENNIS MA
02660-2575
US

V. Phone/Fax

Practice location:
  • Phone: 508-385-5150
  • Fax: 508-385-3435
Mailing address:
  • Phone: 508-385-5150
  • Fax: 508-385-3435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number16094
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: