Provider Demographics
NPI:1730300682
Name:PITTMAN, MARY ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANN
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 58TH STREET NORTH
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-6326
Mailing Address - Country:US
Mailing Address - Phone:727-381-2809
Mailing Address - Fax:727-381-7174
Practice Address - Street 1:1015 58TH STREET NORTH
Practice Address - Street 2:
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-6326
Practice Address - Country:US
Practice Address - Phone:727-381-2809
Practice Address - Fax:727-381-7174
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0111111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice