Provider Demographics
NPI:1740035443
Name:PITTMAN, DELANA
Entity type:Individual
Prefix:
First Name:DELANA
Middle Name:
Last Name:PITTMAN
Suffix:
Gender:U
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19562 NORTHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-2912
Mailing Address - Country:US
Mailing Address - Phone:203-610-9145
Mailing Address - Fax:
Practice Address - Street 1:30890 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-2606
Practice Address - Country:US
Practice Address - Phone:248-478-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902014076124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist