Provider Demographics
NPI:1700566270
Name:PITZER, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:PITZER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 MUNSEY DR
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-2747
Mailing Address - Country:US
Mailing Address - Phone:443-255-0411
Mailing Address - Fax:
Practice Address - Street 1:5330 MOSEBY ST
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:29207
Practice Address - Country:US
Practice Address - Phone:803-751-3255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV4625122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist