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NPI Code Detail

MEDICARE: DR. GENE THOMAS DEWITT DDS

MEDICARE: DR. GENE THOMAS DEWITT DDS
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 Dentistry12956TX

General Provider Information

NPI Number : 1629230925
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GENE THOMAS DEWITT DDS
Provider Business Mailing Address
First Line : 3513 SW WILSHIRE BLVD
Second Line :
City : JOSHUA
State : TX
Zip : 76058-6159
Country : US
Telephone Number : 817-295-4500
Fax Number : 817-295-2001
Provider Business Practice Location Address
First Line : 3513 SW WILSHIRE BLVD
Second Line :
City : JOSHUA
State : TX
Zip : 76058-6159
Country : US
Telephone Number : 817-295-4500
Fax Number : 817-295-2001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2008
Last Update Date : 06/27/2008

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