Provider Demographics
NPI:1497841902
Name:PITTS, THOMAS ERVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ERVIN
Last Name:PITTS
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 1:121 E BROOKS ST
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:64628
Mailing Address - Country:US
Mailing Address - Phone:660-258-3371
Mailing Address - Fax:
Practice Address - Street 1:121 E BROOKS ST
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:MO
Practice Address - Zip Code:64628
Practice Address - Country:US
Practice Address - Phone:660-258-3371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO12564122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist