Provider Demographics
NPI:1780685958
Name:PITUCH, DANIEL W (DMD, MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:W
Last Name:PITUCH
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 COAL VALLEY RD
Mailing Address - Street 2:316 SOUTH HILLS MEDICAL BUILDING
Mailing Address - City:JEFFERSON HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3730
Mailing Address - Country:US
Mailing Address - Phone:412-469-7466
Mailing Address - Fax:412-469-7467
Practice Address - Street 1:575 COAL VALLEY RD
Practice Address - Street 2:316 SOUTH HILLS MEDICAL BUILDING
Practice Address - City:JEFFERSON HILLS
Practice Address - State:PA
Practice Address - Zip Code:15025-3730
Practice Address - Country:US
Practice Address - Phone:412-469-7466
Practice Address - Fax:412-469-7467
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027222L1223S0112X
PAMD060229L1223S0112X
PADA027222A1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PWG33053Medicare UPIN
PWPI865947Medicare ID - Type Unspecified