Provider Demographics
NPI:1366032518
Name:DEWITT DENTAL ASSOCIATES, P. C.
Entity Type:Organization
Organization Name:DEWITT DENTAL ASSOCIATES, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHOONOVER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-669-2225
Mailing Address - Street 1:203 1/2 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-8971
Mailing Address - Country:US
Mailing Address - Phone:517-669-2225
Mailing Address - Fax:
Practice Address - Street 1:203 1/2 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-8971
Practice Address - Country:US
Practice Address - Phone:517-669-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental