Provider Demographics
NPI:1952863219
Name:AARON B. PITTS, DMD INC.
Entity Type:Organization
Organization Name:AARON B. PITTS, DMD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:PITTS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:718-644-2754
Mailing Address - Street 1:28914 OLD HIGHWAY 80 STE 104
Mailing Address - Street 2:
Mailing Address - City:PINE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91962-4411
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28914 OLD HIGHWAY 80 STE 104
Practice Address - Street 2:
Practice Address - City:PINE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91962-4411
Practice Address - Country:US
Practice Address - Phone:619-377-3006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1174840284OtherNPI # 1