Healthcare Provider Details

I. General information

NPI: 1336626944
Provider Name (Legal Business Name): JACOB P. WITER D.M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65893 VAN DYKE RD
WASHINGTON TWP MI
48095-2014
US

IV. Provider business mailing address

65893 VAN DYKE RD
WASHINGTON TWP MI
48095-2014
US

V. Phone/Fax

Practice location:
  • Phone: 586-281-3266
  • Fax: 586-785-3942
Mailing address:
  • Phone: 586-884-3395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JACOB WITER
Title or Position: OWNER
Credential: DMD
Phone: 586-884-3395