Provider Demographics
NPI:1114184702
Name:PITTS, REBECCA (DDS, DMD, DSC)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:PITTS
Suffix:
Gender:F
Credentials:DDS, DMD, DSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 W LAKE MARY BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3570
Mailing Address - Country:US
Mailing Address - Phone:407-688-9990
Mailing Address - Fax:
Practice Address - Street 1:3300 W LAKE MARY BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3570
Practice Address - Country:US
Practice Address - Phone:407-688-9990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00142141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice