MEDICARE: PAMELA ANN WITTMEYER RDH

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	124Q00000X	Dental Hygienist	001786	MO

General Provider Information

NPI Number	:	1679804595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA ANN WITTMEYER RDH

Provider Business Mailing Address
First Line	:	20500 GRASS PAD RD
Second Line	:
City	:	PLATTE CITY
State	:	MO
Zip	:	64079-8295
Country	:	US
Telephone Number	:	816-804-0855
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 HAINES
Second Line	:
City	:	LIBERTY
State	:	MO
Zip	:	64068-1006
Country	:	US
Telephone Number	:	816-595-4306
Fax Number	:

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

Provider Enumeration Date	:	01/15/2010
Last Update Date	:	01/15/2010

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