Provider Demographics
NPI:1952534570
Name:WITKOWSKI, MICHAEL CYPRIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CYPRIAN
Last Name:WITKOWSKI
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 1:20775 OAKHURST MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365
Mailing Address - Country:US
Mailing Address - Phone:832-875-1661
Mailing Address - Fax:
Practice Address - Street 1:2606 GREEN OAK DR STE A
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2490
Practice Address - Country:US
Practice Address - Phone:281-358-6330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-30
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00249031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice