Provider Demographics
NPI:1558457689
Name:PITTSLEY, BRANT SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRANT
Middle Name:SCOTT
Last Name:PITTSLEY
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 1:7550 VILLAGE CT
Mailing Address - Street 2:
Mailing Address - City:DAVISBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48350-2554
Mailing Address - Country:US
Mailing Address - Phone:248-634-7002
Mailing Address - Fax:248-634-9973
Practice Address - Street 1:7550 VILLAGE CT
Practice Address - Street 2:
Practice Address - City:DAVISBURG
Practice Address - State:MI
Practice Address - Zip Code:48350-2554
Practice Address - Country:US
Practice Address - Phone:248-634-7002
Practice Address - Fax:248-634-9973
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI012145122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist