Provider Demographics
NPI:1629460787
Name:DANIEL M. PITTMAN, LLL, DMD, PC
Entity Type:Organization
Organization Name:DANIEL M. PITTMAN, LLL, DMD, PC
Other - Org Name:DOTHAN PERIODONTICS & IMPLANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-793-7232
Mailing Address - Street 1:103 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-6903
Mailing Address - Country:US
Mailing Address - Phone:334-793-7232
Mailing Address - Fax:334-712-7720
Practice Address - Street 1:103 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-6903
Practice Address - Country:US
Practice Address - Phone:334-793-7232
Practice Address - Fax:334-712-7720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL54301223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty