Provider Demographics
NPI:1801018825
Name:DEWITT, MICHAEL N
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:N
Last Name:DEWITT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 E 1ST AVE
Mailing Address - Street 2:SUITE 615
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5810
Mailing Address - Country:US
Mailing Address - Phone:303-321-5656
Mailing Address - Fax:303-321-5341
Practice Address - Street 1:3300 E 1ST AVE
Practice Address - Street 2:SUITE 615
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5810
Practice Address - Country:US
Practice Address - Phone:303-321-5656
Practice Address - Fax:303-321-5341
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1059431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice