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NPI Code Detail

MEDICARE: DR. JEFFREY STEPHEN WITTMUS D.D.S.

MEDICARE:  DR. JEFFREY STEPHEN WITTMUS  D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryIL

General Provider Information

NPI Number : 1255461042
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY STEPHEN WITTMUS D.D.S.
Provider Business Mailing Address
First Line : 5315 N CENTRAL AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60630-1302
Country : US
Telephone Number : 773-631-6060
Fax Number : 773-631-4636
Provider Business Practice Location Address
First Line : 5315 N CENTRAL AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60630-1302
Country : US
Telephone Number : 773-631-6060
Fax Number : 773-631-4636
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2007
Last Update Date : 07/08/2007

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Directions to “ DR. JEFFREY STEPHEN WITTMUS D.D.S.” Practice Location

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