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General NPI Number Information
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NPI Number | 1851598593
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Entity Type | Individual
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Provider Name | ELSA MARIE WITTBOLD DDS
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Gender | Female
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 11/15/2011
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Provider Practice Location Address
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Address Line | 555 W GRANADA BLVD SUITE C-2
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City | ORMOND BEACH
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State | FL
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Zip | 32174-9485
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Country | US
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Telephone | 386-675-6769
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Fax | 386-657-6770
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Provider Business Mailing Address
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Address Line | 555 W GRANADA BLVD SUITE C-2
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City | ORMOND BEACH
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State | FL
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Zip | 32174-9485
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Country | US
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Telephone | 386-675-6769
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Fax | 386-657-6770
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN 18198
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License Number State | FL
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