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NPI 1528027877

NPI 1528027877 : DENNIS J WITT DDS : W HARRISON, IN

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General NPI Number Information
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    NPI Number           |    1528027877
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    Entity Type          |    Individual 
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    Provider Name        |    DENNIS J WITT DDS
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    03/23/2006
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    Last Update Date     |    07/08/2007
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Provider Practice Location Address
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    Address Line         |    27345 N STATE ST 
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    City                 |    W HARRISON
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    State                |    IN
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    Zip                  |    47060-9671
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    Country              |    US
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    Telephone            |    812-637-5647
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    Fax                  |    812-637-5647
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Provider Business Mailing Address
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    Address Line         |    27345 N STATE ST 
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    City                 |    W HARRISON
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    State                |    IN
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    Zip                  |    47060-9671
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    Country              |    US
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    Telephone            |    812-637-5647
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    Fax                  |    812-637-5647
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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       |    12007539A
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    License Number State |    IN
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