Provider Demographics
NPI:1356404719
Name:PITTAWAY, THOMAS ALAN (DMD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALAN
Last Name:PITTAWAY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 1ST AVE W
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4442
Mailing Address - Country:US
Mailing Address - Phone:406-755-7117
Mailing Address - Fax:406-257-1764
Practice Address - Street 1:124 1ST AVE W
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4442
Practice Address - Country:US
Practice Address - Phone:406-755-7117
Practice Address - Fax:406-257-1764
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT18691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice