Provider Demographics
NPI:1326041815
Name:WITT, ROBERT CAMERON (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CAMERON
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 1:206 MEADOW MOUNTAIN DRIVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712
Mailing Address - Country:US
Mailing Address - Phone:908-507-4487
Mailing Address - Fax:908-766-5604
Practice Address - Street 1:206 MEADOW MOUNTAIN DRIVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712
Practice Address - Country:US
Practice Address - Phone:908-507-4487
Practice Address - Fax:908-766-5604
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ173061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice