Provider Demographics
NPI:1326225103
Name:DEWITT FAMILY DENTAL, P.C.
Entity Type:Organization
Organization Name:DEWITT FAMILY DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FEDEWA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:517-669-8864
Mailing Address - Street 1:1025 W HERBISON RD
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-7966
Mailing Address - Country:US
Mailing Address - Phone:517-669-8864
Mailing Address - Fax:517-669-8865
Practice Address - Street 1:1025 W HERBISON RD
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-7966
Practice Address - Country:US
Practice Address - Phone:517-669-8864
Practice Address - Fax:517-669-8865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental