MEDICARE: DR. DAVID D WITSCHEN 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
1	1223G0001X	General Practice Dentistry	10138	MN

General Provider Information

NPI Number	:	1790735512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID D WITSCHEN DDS

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	:

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	:

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	07/08/2007

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