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General NPI Number Information
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NPI Number | 1629230925
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Entity Type | Individual
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Provider Name | GENE THOMAS DEWITT DDS
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Gender | Male
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Dates
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Enumeration Date | 06/27/2008
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Last Update Date | 06/27/2008
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Provider Practice Location Address
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Address Line | 3513 SW WILSHIRE BLVD
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City | JOSHUA
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State | TX
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Zip | 76058-6159
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Country | US
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Telephone | 817-295-4500
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Fax | 817-295-2001
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Provider Business Mailing Address
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Address Line | 3513 SW WILSHIRE BLVD
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City | JOSHUA
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State | TX
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Zip | 76058-6159
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Country | US
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Telephone | 817-295-4500
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Fax | 817-295-2001
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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 | 12956
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License Number State | TX
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