Provider Demographics
NPI:1912087008
Name:PITTMAN, DAVID MALLORY (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MALLORY
Last Name:PITTMAN
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 1:333 21ST AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1849
Mailing Address - Country:US
Mailing Address - Phone:615-327-2630
Mailing Address - Fax:615-321-2015
Practice Address - Street 1:333 21ST AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1849
Practice Address - Country:US
Practice Address - Phone:615-327-2630
Practice Address - Fax:615-321-2015
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN73551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice