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NPI Code Detail

MEDICARE: DR. ROBERT J WITHAM DDS

MEDICARE: DR. ROBERT J WITHAM 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 Dentistry12005952BIN

General Provider Information

NPI Number : 1699800755
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT J WITHAM DDS
Provider Business Mailing Address
First Line : 5470 LAFAYETTE RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46254-1620
Country : US
Telephone Number : 317-293-4611
Fax Number : 317-297-7504
Provider Business Practice Location Address
First Line : 5470 LAFAYETTE RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46254-1620
Country : US
Telephone Number : 317-293-4611
Fax Number : 317-297-7504
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2007
Last Update Date : 07/08/2007

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Directions to “ DR. ROBERT J WITHAM DDS” Practice Location

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