Provider Demographics
NPI:1629230925
Name:DEWITT, GENE THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:THOMAS
Last Name:DEWITT
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 1:3513 SW WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:JOSHUA
Mailing Address - State:TX
Mailing Address - Zip Code:76058-6159
Mailing Address - Country:US
Mailing Address - Phone:817-295-4500
Mailing Address - Fax:817-295-2001
Practice Address - Street 1:3513 SW WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:JOSHUA
Practice Address - State:TX
Practice Address - Zip Code:76058-6159
Practice Address - Country:US
Practice Address - Phone:817-295-4500
Practice Address - Fax:817-295-2001
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX129561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice