Provider Demographics
NPI:1275681967
Name:PINE BELT PERIODONTICS, PLLC
Entity Type:Organization
Organization Name:PINE BELT PERIODONTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:PITFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:601-264-2424
Mailing Address - Street 1:9 MEDICAL BLVD
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7231
Mailing Address - Country:US
Mailing Address - Phone:601-264-2424
Mailing Address - Fax:601-264-2410
Practice Address - Street 1:9 MEDICAL BLVD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7231
Practice Address - Country:US
Practice Address - Phone:601-264-2424
Practice Address - Fax:601-264-2410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2568-901223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty