Provider Demographics
NPI:1801008818
Name:WITEK, THOMAS JENS (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JENS
Last Name:WITEK
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 1:2581 DEVELOPMENT DRIVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311
Mailing Address - Country:US
Mailing Address - Phone:920-347-2600
Mailing Address - Fax:920-347-2604
Practice Address - Street 1:2581 DEVELOPMENT DRIVE
Practice Address - Street 2:SUITE 202
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311
Practice Address - Country:US
Practice Address - Phone:920-347-2600
Practice Address - Fax:920-347-2604
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45501223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics