Provider Demographics
NPI:1841364429
Name:WITTIG, GREGORY J (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:J
Last Name:WITTIG
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:PO BOX 152
Mailing Address - Street 2:
Mailing Address - City:KNOX
Mailing Address - State:IN
Mailing Address - Zip Code:46534-0152
Mailing Address - Country:US
Mailing Address - Phone:574-772-3666
Mailing Address - Fax:574-772-5643
Practice Address - Street 1:1800 S. U.S. 35
Practice Address - Street 2:
Practice Address - City:KNOX
Practice Address - State:IN
Practice Address - Zip Code:46534-0152
Practice Address - Country:US
Practice Address - Phone:574-772-3666
Practice Address - Fax:574-772-5643
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007915A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist