Provider Demographics
NPI:1205940335
Name:WITTKOWSKI, VICTOR GEORGE (DDS)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:GEORGE
Last Name:WITTKOWSKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6649 ROCHESTER RD SUITE C
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085
Mailing Address - Country:US
Mailing Address - Phone:248-879-7240
Mailing Address - Fax:248-879-2034
Practice Address - Street 1:6649 ROCHESTER RD SUITE C
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085
Practice Address - Country:US
Practice Address - Phone:248-879-7240
Practice Address - Fax:248-879-2034
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901010984122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist