Individual
ANNA WITANTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
2701 DECOTO RD, SUITE 1, UNION CITY, CA 94587-4940
(510) 489-6900
(510) 324-1759
Mailing address
104 RUSH CREEK CT, SAN RAMON, CA 94582-5624
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
44642
CA
Other
Enumeration date
02/08/2007
Last updated
07/08/2007
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