Healthcare Provider Details

I. General information

NPI: 1528016425
Provider Name (Legal Business Name): KIMBER DEWITT D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 N BROWN ST
MT PLEASANT MI
48858-1929
US

IV. Provider business mailing address

711 N BROWN ST
MT PLEASANT MI
48858-1929
US

V. Phone/Fax

Practice location:
  • Phone: 989-772-3939
  • Fax: 989-772-9026
Mailing address:
  • Phone: 989-772-3939
  • Fax: 989-772-9026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2901014332
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: