Individual
DR. ELSA MARIE WITTBOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
555 W GRANADA BLVD, SUITE C-2, ORMOND BEACH, FL 32174-9485
(386) 675-6769
(386) 657-6770
Mailing address
555 W GRANADA BLVD, SUITE C-2, ORMOND BEACH, FL 32174-9485
(386) 675-6769
(386) 657-6770
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN 18198
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN18198
DENTAL LICENSE
FL
01
—
DT-1511
DENTTAL LICENSE
HI
Enumeration date
06/27/2007
Last updated
11/15/2011
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