Provider Demographics
NPI:1669740916
Name:PITTMAN, LANCE M (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:LANCE
Middle Name:M
Last Name:PITTMAN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 SUSHRUTA DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-8802
Mailing Address - Country:US
Mailing Address - Phone:304-596-0425
Mailing Address - Fax:
Practice Address - Street 1:1004 SUSHRUTA DR
Practice Address - Street 2:SUITE B
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-8802
Practice Address - Country:US
Practice Address - Phone:304-596-0425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-01
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV39501223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics