Provider Demographics
NPI:1083735450
Name:WITT, THEODORE C (DDS)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:C
Last Name:WITT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26932 OSO PKWY
Mailing Address - Street 2:SUITE 280
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5815
Mailing Address - Country:US
Mailing Address - Phone:949-582-6460
Mailing Address - Fax:949-582-5991
Practice Address - Street 1:26932 OSO PKWY
Practice Address - Street 2:SUITE 280
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5815
Practice Address - Country:US
Practice Address - Phone:949-582-6460
Practice Address - Fax:949-582-5991
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18438122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist