Provider Demographics
NPI:1871670430
Name:WITTMER, SEAN L (DMD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:L
Last Name:WITTMER
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 1:10904 GRAVELLY LAKE DR SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-1330
Mailing Address - Country:US
Mailing Address - Phone:253-589-3636
Mailing Address - Fax:253-589-3177
Practice Address - Street 1:10904 GRAVELLY LAKE DR SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-1330
Practice Address - Country:US
Practice Address - Phone:253-589-3636
Practice Address - Fax:253-589-3177
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000078821223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics