Provider Demographics
NPI:1982377784
Name:PITTMAN, SHANNON B (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:B
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 RANDOLPH STILL RD
Mailing Address - Street 2:
Mailing Address - City:GOOD HOPE
Mailing Address - State:GA
Mailing Address - Zip Code:30641-2147
Mailing Address - Country:US
Mailing Address - Phone:770-298-9754
Mailing Address - Fax:
Practice Address - Street 1:3446 WINDER HWY STE 501-Q
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-3007
Practice Address - Country:US
Practice Address - Phone:770-297-5110
Practice Address - Fax:770-297-5173
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN122451122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist