Provider Demographics
NPI:1891132965
Name:PITTMAN, TRACY LEE (DENTAL HYGIENIST)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LEE
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:LEE
Other - Last Name:LEONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5095 RIFLE RIVER TRAIL
Mailing Address - Street 2:
Mailing Address - City:ALGER
Mailing Address - State:MI
Mailing Address - Zip Code:48610
Mailing Address - Country:US
Mailing Address - Phone:989-873-5152
Mailing Address - Fax:989-873-5913
Practice Address - Street 1:STERLING AREA DENTAL OFFICE
Practice Address - Street 2:5095 RIFLE RIVER TRAIL
Practice Address - City:ALGER
Practice Address - State:MI
Practice Address - Zip Code:48610
Practice Address - Country:US
Practice Address - Phone:989-873-5152
Practice Address - Fax:989-873-5913
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902013094124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist