MEDICARE: JAMES P. WITCHER 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	DG 29529	CA

General Provider Information

NPI Number	:	1861557514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES P. WITCHER D.D.S.

Provider Business Mailing Address
First Line	:	5417 STARDUST WAY
Second Line	:
City	:	BONSALL
State	:	CA
Zip	:	92003-3740
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2152 KURTZ ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-2024
Country	:	US
Telephone Number	:	619-849-8658
Fax Number	:

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

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	04/20/2022

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