Provider Demographics
NPI:1871710772
Name:WITKOSKY, GARY (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:WITKOSKY
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 1:2637 BRIARWOOD PL
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-1305
Mailing Address - Country:US
Mailing Address - Phone:818-517-6869
Mailing Address - Fax:805-493-2710
Practice Address - Street 1:200 S WELLS RD
Practice Address - Street 2:200
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004-1302
Practice Address - Country:US
Practice Address - Phone:805-659-1740
Practice Address - Fax:805-659-9959
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30242122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist