Provider Demographics
NPI:1558913103
Name:PITCHOK, KAITLYN LOUISE
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:LOUISE
Last Name:PITCHOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 FRANK LAYMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43953-3770
Mailing Address - Country:US
Mailing Address - Phone:740-264-4493
Mailing Address - Fax:
Practice Address - Street 1:444 FRANK LAYMAN BLVD
Practice Address - Street 2:
Practice Address - City:WINTERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43953-3770
Practice Address - Country:US
Practice Address - Phone:740-264-4493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-14
Last Update Date:2019-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.025887122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist