Provider Demographics
NPI:1346220530
Name:PITTMAN, DEIRDRE LONG (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEIRDRE
Middle Name:LONG
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 TOWNE CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-7405
Mailing Address - Country:US
Mailing Address - Phone:407-330-3601
Mailing Address - Fax:407-330-3021
Practice Address - Street 1:205 TOWNE CENTER BLVD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-7405
Practice Address - Country:US
Practice Address - Phone:407-330-3601
Practice Address - Fax:407-330-3021
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17275122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist