Provider Demographics
NPI:1649321027
Name:WITEK, EDWARD L JR (DMD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:L
Last Name:WITEK
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7829 NATIONAL PIKE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-5104
Mailing Address - Country:US
Mailing Address - Phone:724-439-1616
Mailing Address - Fax:724-439-8782
Practice Address - Street 1:7829 NATIONAL PIKE
Practice Address - Street 2:SUITE 1
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-5104
Practice Address - Country:US
Practice Address - Phone:724-439-1616
Practice Address - Fax:724-439-8782
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020660-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice