Provider Demographics
NPI:1629522271
Name:WITT, DAVID LEE (DMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:WITT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 EXECUTIVE PARK DR NE APT 2111
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2268
Mailing Address - Country:US
Mailing Address - Phone:270-519-3483
Mailing Address - Fax:
Practice Address - Street 1:1630 PLEASANT HILL RD STE 200
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5828
Practice Address - Country:US
Practice Address - Phone:770-381-7878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015257122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist