MEDICARE: DAVID D WITSCHEN D.D.S. PA

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
1	122300000X	Dentist

General Provider Information

NPI Number	:	1417767922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID D WITSCHEN D.D.S. PA

Provider Business Mailing Address
First Line	:	710 9TH ST N
Second Line	:
City	:	VIRGINIA
State	:	MN
Zip	:	55792-2322
Country	:	US
Telephone Number	:	218-741-5070
Fax Number	:	218-293-6002

Provider Business Practice Location Address
First Line	:	710 9TH ST N
Second Line	:
City	:	VIRGINIA
State	:	MN
Zip	:	55792-2322
Country	:	US
Telephone Number	:	218-741-5070
Fax Number	:	218-293-6002

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID D WITSCHEN
Credential	:	DDS
Telephone Number	:	218-741-5070

Provider Enumeration Date	:	01/08/2025
Last Update Date	:	01/08/2025

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