Provider Demographics
NPI:1265595284
Name:DEWITT, WILLIAM LLOYD (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LLOYD
Last Name:DEWITT
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 1:700 WASHINGTON AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-1466
Mailing Address - Country:US
Mailing Address - Phone:616-842-3480
Mailing Address - Fax:616-842-9997
Practice Address - Street 1:700 WASHINGTON AVE STE 120
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1466
Practice Address - Country:US
Practice Address - Phone:616-842-3480
Practice Address - Fax:616-842-9997
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901014493122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist