Provider Demographics
NPI:1841212214
Name:PITTAWAY, JOHN FRITTS (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FRITTS
Last Name:PITTAWAY
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 1:1415 KALAKAUA AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1920
Mailing Address - Country:US
Mailing Address - Phone:808-946-9952
Mailing Address - Fax:866-453-7200
Practice Address - Street 1:1415 KALAKAUA AVE STE 211
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1920
Practice Address - Country:US
Practice Address - Phone:808-946-9952
Practice Address - Fax:866-453-7200
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI15431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04899301Medicaid