Provider Demographics
NPI:1790893899
Name:WITTEMAN, LORI LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:LEE
Last Name:WITTEMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 EAST 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BOTTINEAU
Mailing Address - State:ND
Mailing Address - Zip Code:58318
Mailing Address - Country:US
Mailing Address - Phone:701-228-3153
Mailing Address - Fax:
Practice Address - Street 1:109 EAST 5TH ST
Practice Address - Street 2:
Practice Address - City:BOTTINEAU
Practice Address - State:ND
Practice Address - Zip Code:58318
Practice Address - Country:US
Practice Address - Phone:701-228-3153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1679122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
901679OtherBLUE CROSS BLUE SHIELD
ND40847Medicaid
ND40847Medicaid