Provider Demographics
NPI:1922142660
Name:PITTS, GARRY EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARRY
Middle Name:EUGENE
Last Name:PITTS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31053 BLUE SPRUCE DRIVE
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860
Mailing Address - Country:US
Mailing Address - Phone:406-883-2704
Mailing Address - Fax:406-883-2708
Practice Address - Street 1:308 MISSION DR
Practice Address - Street 2:
Practice Address - City:ST IGNATIUS
Practice Address - State:MT
Practice Address - Zip Code:59865-9676
Practice Address - Country:US
Practice Address - Phone:406-883-7329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1874122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT5511974OtherCHIP
MT0112149Medicaid