Healthcare Provider Details

I. General information

NPI: 1457479842
Provider Name (Legal Business Name): ERNEST THOMPSON WITTE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 JANAF OFFICE BLDG 5900 E VA BEACH BLVD
NORFOLK VA
23502-2508
US

IV. Provider business mailing address

213 JANAF OFFICE BLDG 5900 E VA BEACH BLVD
NORFOLK VA
23502-2508
US

V. Phone/Fax

Practice location:
  • Phone: 757-461-3660
  • Fax: 751-461-4580
Mailing address:
  • Phone: 757-461-3660
  • Fax: 751-461-4580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number0401006391
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: