Provider Demographics
NPI:1528016425
Name:DEWITT, KIMBER (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:KIMBER
Middle Name:
Last Name:DEWITT
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 N BROWN ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-1929
Mailing Address - Country:US
Mailing Address - Phone:989-772-3939
Mailing Address - Fax:989-772-9026
Practice Address - Street 1:711 N BROWN ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-1929
Practice Address - Country:US
Practice Address - Phone:989-772-3939
Practice Address - Fax:989-772-9026
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010143321223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2573282Medicaid