Provider Demographics
NPI:1497809099
Name:DOUGLAS A. WITTE, DDS, MS, INC.
Entity Type:Organization
Organization Name:DOUGLAS A. WITTE, DDS, MS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:WITTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:903-593-9777
Mailing Address - Street 1:1029 E IDEL ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2025
Mailing Address - Country:US
Mailing Address - Phone:903-593-9777
Mailing Address - Fax:903-593-4110
Practice Address - Street 1:1029 E IDEL ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2025
Practice Address - Country:US
Practice Address - Phone:903-593-9777
Practice Address - Fax:903-593-4110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX94131223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty