Provider Demographics
NPI:1073721098
Name:GREGORY C. WITT D.D.S.,MARJORIE A. TAYLOR D.D.S., P.C.
Entity Type:Organization
Organization Name:GREGORY C. WITT D.D.S.,MARJORIE A. TAYLOR D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:C
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:563-359-4270
Mailing Address - Street 1:2466 E KIMBERLY RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2338
Mailing Address - Country:US
Mailing Address - Phone:563-359-4270
Mailing Address - Fax:
Practice Address - Street 1:2466 E KIMBERLY RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2338
Practice Address - Country:US
Practice Address - Phone:563-359-4270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA61681223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty