Provider Demographics
NPI:1174519904
Name:PITTS, RICHARD S (DMD)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:S
Last Name:PITTS
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 1:935 S MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-5717
Mailing Address - Country:US
Mailing Address - Phone:918-224-8150
Mailing Address - Fax:918-224-8160
Practice Address - Street 1:935 S MISSION ST
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-5717
Practice Address - Country:US
Practice Address - Phone:918-224-8150
Practice Address - Fax:918-224-8160
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice