Provider Demographics
NPI:1497008460
Name:WITT, DAVIS WESLEY (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVIS
Middle Name:WESLEY
Last Name:WITT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:207 MIRICK RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MA
Mailing Address - Zip Code:01541-1115
Mailing Address - Country:US
Mailing Address - Phone:978-464-5179
Mailing Address - Fax:508-829-4616
Practice Address - Street 1:1406 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520-1090
Practice Address - Country:US
Practice Address - Phone:508-829-7650
Practice Address - Fax:508-829-4616
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA179001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics