Provider Demographics
NPI:1457479842
Name:WITTE, ERNEST THOMPSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:THOMPSON
Last Name:WITTE
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 1:213 JANAF OFFICE BLDG
Mailing Address - Street 2:5900 E VA BEACH BLVD
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-2508
Mailing Address - Country:US
Mailing Address - Phone:757-461-3660
Mailing Address - Fax:751-461-4580
Practice Address - Street 1:213 JANAF OFFICE BLDG
Practice Address - Street 2:5900 E VA BEACH BLVD
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-2508
Practice Address - Country:US
Practice Address - Phone:757-461-3660
Practice Address - Fax:751-461-4580
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010063911223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics