Provider Demographics
NPI:1023101805
Name:WITT, BRIAN RICHARD (DMD PA)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:RICHARD
Last Name:WITT
Suffix:
Gender:M
Credentials:DMD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13214 TELECOM DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-0932
Mailing Address - Country:US
Mailing Address - Phone:813-988-7489
Mailing Address - Fax:813-977-7004
Practice Address - Street 1:13214 TELECOM DR
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33637-0932
Practice Address - Country:US
Practice Address - Phone:813-988-7489
Practice Address - Fax:813-977-7004
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14117122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist