Provider Demographics
NPI:1710078852
Name:WITT, DARYL BAYARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:DARYL
Middle Name:BAYARD
Last Name:WITT
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:PO BOX 5066
Mailing Address - Street 2:
Mailing Address - City:LAYTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20882
Mailing Address - Country:US
Mailing Address - Phone:301-977-8855
Mailing Address - Fax:301-977-8856
Practice Address - Street 1:6835 OLNEY LAYTONSVILLE ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:LAYTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20882
Practice Address - Country:US
Practice Address - Phone:301-977-8855
Practice Address - Fax:301-977-8856
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD059331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice