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General NPI Number Information
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NPI Number | 1508366717
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Entity Type | Individual
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Provider Name | MATTHEW MARK WITKOWSKI DMD
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Gender | Male
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Dates
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Enumeration Date | 02/14/2018
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 20 EXECUTIVE CT STE 1
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City | SOUTH BARRINGTON
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State | IL
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Zip | 60010-9543
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Country | US
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Telephone | 847-550-3460
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Fax |
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Provider Business Mailing Address
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Address Line | 2405 RIVER WOODS DR
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City | NAPERVILLE
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State | IL
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Zip | 60565-6356
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Country | US
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Telephone | 313-407-6569
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019032088
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | RES-30652
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License Number State | IA
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Taxonomy #4
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 021.003457
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License Number State | IL
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