MEDICARE: DR. MATTHEW SCOTT WITTRIG 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
1	1223G0001X	General Practice Dentistry	12009205	IN

General Provider Information

NPI Number	:	1497799423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW SCOTT WITTRIG D.D.S.

Provider Business Mailing Address
First Line	:	7748 MADISON AVE
Second Line	:	SUITE B
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-5608
Country	:	US
Telephone Number	:	317-882-4028
Fax Number	:

Provider Business Practice Location Address
First Line	:	7748 MADISON AVE
Second Line	:	SUITE B
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-5608
Country	:	US
Telephone Number	:	317-882-4028
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	08/16/2007

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