Provider Demographics
NPI:1881640779
Name:WITCHER, SETH L (DDS)
Entity type:Individual
Prefix:DR
First Name:SETH
Middle Name:L
Last Name:WITCHER
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 1:126 WILLIAM CLASSEN DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1321
Mailing Address - Country:US
Mailing Address - Phone:210-490-6074
Mailing Address - Fax:
Practice Address - Street 1:4025 E SOUTHCROSS BLVD
Practice Address - Street 2:BLDG 1, SUITE 5
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78222-3641
Practice Address - Country:US
Practice Address - Phone:210-337-8600
Practice Address - Fax:210-337-8606
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120891223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD12089Medicare ID - Type Unspecified
TXT16704Medicare UPIN