Healthcare Provider Details

I. General information

NPI: 1790735512
Provider Name (Legal Business Name): DAVID D WITSCHEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 9TH ST N
VIRGINIA MN
55792-2322
US

IV. Provider business mailing address

710 9TH ST N
VIRGINIA MN
55792-2322
US

V. Phone/Fax

Practice location:
  • Phone: 218-741-5070
  • Fax:
Mailing address:
  • Phone: 218-741-5070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10138
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: