Healthcare Provider Details

I. General information

NPI: 1528411600
Provider Name (Legal Business Name): RICHARD G WITTER, DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 07/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 E 27TH AVE # 200
SPOKANE WA
99223-4919
US

IV. Provider business mailing address

3150 E 27TH AVE # 200
SPOKANE WA
99223-4919
US

V. Phone/Fax

Practice location:
  • Phone: 509-838-4141
  • Fax:
Mailing address:
  • Phone: 509-838-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code126900000X
TaxonomyDental Laboratory Technician
License Number
License Number State

VIII. Authorized Official

Name: ANGELA G WITTER
Title or Position: OFFICE MANAGER
Credential:
Phone: 509-838-4141