Provider Demographics
NPI:1023228061
Name:PITTMAN, TYLER RAY (DDS)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:RAY
Last Name:PITTMAN
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 1:904 E SNYDER AVE
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:OH
Mailing Address - Zip Code:43543-1276
Mailing Address - Country:US
Mailing Address - Phone:419-485-4605
Mailing Address - Fax:
Practice Address - Street 1:904 E SNYDER AVE
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:OH
Practice Address - Zip Code:43543-1276
Practice Address - Country:US
Practice Address - Phone:419-485-4605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6213728-99211223G0001X
OH30.0224831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice