Provider Demographics
NPI:1750657441
Name:DAVID E. DEWITT DDS
Entity Type:Organization
Organization Name:DAVID E. DEWITT DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:DEWITT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-558-2261
Mailing Address - Street 1:4841 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3939
Mailing Address - Country:US
Mailing Address - Phone:305-558-2261
Mailing Address - Fax:305-557-9242
Practice Address - Street 1:4841 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3939
Practice Address - Country:US
Practice Address - Phone:305-558-2261
Practice Address - Fax:305-557-9242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN3920122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty