Provider Demographics
NPI:1942451414
Name:WITTENAUER, RICHARD C (DDS)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:C
Last Name:WITTENAUER
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 1:180 NEWPORT CENTER DR # 204
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-6972
Mailing Address - Country:US
Mailing Address - Phone:949-729-2200
Mailing Address - Fax:949-729-9902
Practice Address - Street 1:180 NEWPORT CENTER DR # 204
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-6972
Practice Address - Country:US
Practice Address - Phone:949-729-2200
Practice Address - Fax:949-729-9902
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA521441223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics