Provider Demographics
NPI:1568511681
Name:PITTMAN, MARVIN BENJAMIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:BENJAMIN
Last Name:PITTMAN
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 1:1818 S WESTERN AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-5860
Mailing Address - Country:US
Mailing Address - Phone:323-731-8586
Mailing Address - Fax:323-731-2721
Practice Address - Street 1:1818 S WESTERN AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-5860
Practice Address - Country:US
Practice Address - Phone:323-731-8586
Practice Address - Fax:323-731-2721
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19953122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist