Provider Demographics
NPI:1275257248
Name:JOHN F PITTAWAY DMD LLC
Entity Type:Organization
Organization Name:JOHN F PITTAWAY DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FRITTS
Authorized Official - Last Name:PITTAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:808-373-6200
Mailing Address - Street 1:124 1ST AVE W
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4442
Mailing Address - Country:US
Mailing Address - Phone:406-755-7117
Mailing Address - Fax:
Practice Address - Street 1:124 1ST AVE W
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4442
Practice Address - Country:US
Practice Address - Phone:406-755-7117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental