Provider Demographics
NPI:1942476478
Name:PITTS, DAN OWEN (D D S)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:OWEN
Last Name:PITTS
Suffix:
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 SMITH WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-8035
Mailing Address - Country:US
Mailing Address - Phone:907-262-4989
Mailing Address - Fax:907-262-6595
Practice Address - Street 1:155 SMITH WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-8035
Practice Address - Country:US
Practice Address - Phone:907-262-4989
Practice Address - Fax:907-262-6595
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA 7081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice