Provider Demographics
NPI:1497987457
Name:WITTY, CASEY DANIELLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:DANIELLE
Last Name:WITTY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-2589
Mailing Address - Country:US
Mailing Address - Phone:859-881-4633
Mailing Address - Fax:859-885-2663
Practice Address - Street 1:704 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-2589
Practice Address - Country:US
Practice Address - Phone:859-881-4633
Practice Address - Fax:859-885-2663
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8749122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist