Provider Demographics
NPI:1265583603
Name:PITTMAN, DOUGLAS S (DDS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:S
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 1:6139 E 91ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-3104
Mailing Address - Country:US
Mailing Address - Phone:918-492-8577
Mailing Address - Fax:918-491-7314
Practice Address - Street 1:6139 E 91ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-3104
Practice Address - Country:US
Practice Address - Phone:918-492-8577
Practice Address - Fax:918-491-7314
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK46251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice