Provider Demographics
NPI:1740870393
Name:GRANT PITT DDS PLLC
Entity type:Organization
Organization Name:GRANT PITT DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:PITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-641-3747
Mailing Address - Street 1:2621 LOBLOLLY LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-1252
Mailing Address - Country:US
Mailing Address - Phone:405-226-3474
Mailing Address - Fax:
Practice Address - Street 1:17840 N PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-9097
Practice Address - Country:US
Practice Address - Phone:405-509-2286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty