Jessica R Wittman, DDS
Individual provider Active NPI General Practice Dentistry · Santa Claus, IN
NPI 1194776583 · NPPES record last updated Nov 5, 2010
Key facts
- NPI
- 1194776583
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 12010597 (IN)
- Practice address
- 1 N Kringle Place Blvd
Suite a
Santa Claus, IN 47579-6153 - Phone
- (812) 937-9750
- Fax
- (812) 937-9760
- NPI assigned
- May 12, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12010597 | IN | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12010597 | IN | Yes |
Addresses
Primary practice location
1 N Kringle Place Blvd
Suite a
Santa Claus, IN 47579-6153
Mailing address
1 N Kringle Place Blvd
Suite a
Santa Claus, IN 47579
Phone (812) 937-9750
Other providers in Santa Claus, IN
- Joseph Leland Rapp'E
- Santa Claus Vol. Fire Dept. Inc.
- Debra Schroer
- Paige A Tolbert
- Madeleine Grace Vinson
- Your Family Pharmacy LLC
All providers in Santa Claus, IN · General Practice Dentistry in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 5, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.