Provider Demographics
NPI:1437153798
Name:PITMON, STEPHEN MONROE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MONROE
Last Name:PITMON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 ROOSEVELT HWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-4460
Mailing Address - Country:US
Mailing Address - Phone:802-862-5052
Mailing Address - Fax:802-660-3991
Practice Address - Street 1:875 ROOSEVELT HWY
Practice Address - Street 2:SUITE 110
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-4460
Practice Address - Country:US
Practice Address - Phone:802-862-5052
Practice Address - Fax:802-660-3991
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-02
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016-00010721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1003378Medicaid