Provider Demographics
NPI:1962483776
Name:BIRD AND WITTENBERG DENTAL PARTNERSHIP
Entity Type:Organization
Organization Name:BIRD AND WITTENBERG DENTAL PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDD
Authorized Official - Middle Name:B
Authorized Official - Last Name:WITTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-593-0403
Mailing Address - Street 1:7222 COMMERCE CENTER DR
Mailing Address - Street 2:STE 247
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919
Mailing Address - Country:US
Mailing Address - Phone:719-593-0403
Mailing Address - Fax:719-593-0767
Practice Address - Street 1:7222 COMMERCE CENTER DR
Practice Address - Street 2:STE 247
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919
Practice Address - Country:US
Practice Address - Phone:719-593-0403
Practice Address - Fax:719-593-0767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO67751223G0001X
CO51111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
823010OtherUNITED CONCORDIA DR BIRD
777871OtherUNITED CONCORDIA DR W