Provider Demographics
NPI:1649790536
Name:WITTY, CONNOR WILLIAM (DDS)
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:WILLIAM
Last Name:WITTY
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 1:27 OLD POSTAL RD
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:NY
Mailing Address - Zip Code:10516-3755
Mailing Address - Country:US
Mailing Address - Phone:473-674-4377
Mailing Address - Fax:
Practice Address - Street 1:2401 C AVE
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:VA
Practice Address - Zip Code:24801
Practice Address - Country:US
Practice Address - Phone:571-231-6006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-22
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014156521223G0001X
NY0638421223S0112X
VA04380004601223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice