Healthcare Provider Details

I. General information

NPI: 1932123445
Provider Name (Legal Business Name): JOSEPH LAWRENCE WITTIG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 EUCLID AVE
KANSAS CITY MO
64124-2323
US

IV. Provider business mailing address

825 EUCLID AVE
KANSAS CITY MO
64124-2323
US

V. Phone/Fax

Practice location:
  • Phone: 816-474-4920
  • Fax: 816-889-1845
Mailing address:
  • Phone: 816-474-4920
  • Fax: 816-889-1845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2013010344
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: