Active NPI
Gary Witkosky, D.D.S.
- Dentist
- Ventura, CA
National Provider Identifier
1871710772
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 30242
- Practice address
- 200 S Wells Rd
200
Ventura, CA 93004-1302 - Phone
- (805) 659-1740
- Fax
- (805) 659-9959
- NPI assigned
- Apr 20, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 30242 | CA | Primary |
Addresses
Primary practice location
200 S Wells Rd
200
Ventura, CA 93004-1302
Mailing address
2637 Briarwood PL
Thousand Oaks, CA 91362-1305
Phone (818) 517-6869
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160119001680 | CA | Order and Referring Only - Oral Surgery | 2264735679 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30242 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1871710772",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2637 BRIARWOOD PL",
"city": "THOUSAND OAKS",
"state": "CA",
"postal_code": "913621305",
"telephone_number": "818-517-6869",
"fax_number": "805-493-2710"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 S WELLS RD",
"address_2": "200",
"city": "VENTURA",
"state": "CA",
"postal_code": "930041302",
"telephone_number": "805-659-1740",
"fax_number": "805-659-9959"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WITKOSKY",
"first_name": "GARY",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "30242",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ventura, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.