Provider Demographics
NPI:1760656573
Name:DITCHKUS, WILLIAM S (DMD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:S
Last Name:DITCHKUS
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 1:1016 ROUTE 37 W
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-5020
Mailing Address - Country:US
Mailing Address - Phone:732-349-5004
Mailing Address - Fax:732-914-9780
Practice Address - Street 1:1016 ROUTE 37 W
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5020
Practice Address - Country:US
Practice Address - Phone:732-349-5004
Practice Address - Fax:732-914-9780
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ109341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice