Provider Demographics
NPI:1629116272
Name:PITARO, ROSEMARY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROSEMARY
Middle Name:
Last Name:PITARO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15510 LIVERNOIS
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48238
Mailing Address - Country:US
Mailing Address - Phone:313-863-2800
Mailing Address - Fax:313-863-5054
Practice Address - Street 1:15510 LIVERNOIS
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238
Practice Address - Country:US
Practice Address - Phone:313-863-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010171361223G0001X
MI17136122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice