Healthcare Provider Details

I. General information

NPI: 1588420848
Provider Name (Legal Business Name): REBECCA MARY WITT DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 FOREST AVE STE 110
RICHMOND VA
23230-1730
US

IV. Provider business mailing address

6900 FOREST AVE STE 110
RICHMOND VA
23230-1730
US

V. Phone/Fax

Practice location:
  • Phone: 804-893-8692
  • Fax: 804-285-1292
Mailing address:
  • Phone: 804-893-8692
  • Fax: 804-285-1292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0442000514
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: