Provider Demographics
NPI:1902819303
Name:MASTROS & WITTY FAMILY DENTISTRY PC
Entity Type:Organization
Organization Name:MASTROS & WITTY FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:MASTROS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-249-5128
Mailing Address - Street 1:41 OLD OYSTER POINT RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-7177
Mailing Address - Country:US
Mailing Address - Phone:757-249-5128
Mailing Address - Fax:757-249-0875
Practice Address - Street 1:41 OLD OYSTER POINT RD
Practice Address - Street 2:SUITE H
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-7177
Practice Address - Country:US
Practice Address - Phone:757-249-5128
Practice Address - Fax:757-249-0875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411471261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental