Provider Demographics
NPI:1770643082
Name:PITTS, BRADLEY REEDER (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:REEDER
Last Name:PITTS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 OLD CHAPIN RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-2005
Mailing Address - Country:US
Mailing Address - Phone:803-808-1778
Mailing Address - Fax:803-808-1821
Practice Address - Street 1:117 OLD CHAPIN RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2005
Practice Address - Country:US
Practice Address - Phone:803-808-1778
Practice Address - Fax:803-808-1821
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX3777Medicaid