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NPI Code Detail

MEDICARE: DR. CHAD MARK WITKOW D.D.S.

MEDICARE: DR. CHAD MARK WITKOW 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 Dentistry2901018384MI

General Provider Information

NPI Number : 1316099179
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHAD MARK WITKOW D.D.S.
Provider Business Mailing Address
First Line : 4279 W VIENNA RD
Second Line :
City : CLIO
State : MI
Zip : 48420-9440
Country : US
Telephone Number : 810-659-1721
Fax Number : 810-659-0897
Provider Business Practice Location Address
First Line : 4279 W VIENNA RD
Second Line :
City : CLIO
State : MI
Zip : 48420-9440
Country : US
Telephone Number : 810-659-1721
Fax Number : 810-659-1721
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2007
Last Update Date : 09/14/2020

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