Provider Demographics
NPI:1639175748
Name:WITTWER, RYAN C (DDS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:C
Last Name:WITTWER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4420 TOWN CENTER BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-7137
Mailing Address - Country:US
Mailing Address - Phone:916-941-1122
Mailing Address - Fax:916-941-1149
Practice Address - Street 1:4420 TOWN CENTER BLVD STE 220
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-7137
Practice Address - Country:US
Practice Address - Phone:916-941-1122
Practice Address - Fax:916-941-1149
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX221341223P0221X
CA569891223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1723256-01Medicaid