Provider Demographics
NPI:1740201375
Name:WITTGEN, JOHN B (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:WITTGEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:701 N WEINBACH
Mailing Address - Street 2:STE 910
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47711
Mailing Address - Country:US
Mailing Address - Phone:812-477-2836
Mailing Address - Fax:812-477-1011
Practice Address - Street 1:701 N WEINBACH
Practice Address - Street 2:STE 910
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711
Practice Address - Country:US
Practice Address - Phone:812-477-2836
Practice Address - Fax:812-477-1011
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12006664A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry