Provider Demographics
NPI:1417987967
Name:WITT, WILLIAM M (MAGD DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:M
Last Name:WITT
Suffix:
Gender:M
Credentials:MAGD DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23320 N STATE ROAD 235
Mailing Address - Street 2:
Mailing Address - City:BROOKER
Mailing Address - State:FL
Mailing Address - Zip Code:32622-5266
Mailing Address - Country:US
Mailing Address - Phone:352-485-2772
Mailing Address - Fax:352-485-1961
Practice Address - Street 1:23320 N STATE ROAD 235
Practice Address - Street 2:
Practice Address - City:BROOKER
Practice Address - State:FL
Practice Address - Zip Code:32622-5266
Practice Address - Country:US
Practice Address - Phone:352-485-2772
Practice Address - Fax:352-485-1961
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN61881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL85210OtherBCBS
FL512206OtherUNITED CONCORDIA