Provider Demographics
NPI:1447279120
Name:PITTS, MARK ALEXANDER (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALEXANDER
Last Name:PITTS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 DIXON RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-8137
Mailing Address - Country:US
Mailing Address - Phone:301-874-1855
Mailing Address - Fax:
Practice Address - Street 1:6550 MERCANTILE DR E
Practice Address - Street 2:SUITE 101
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-7547
Practice Address - Country:US
Practice Address - Phone:301-698-5208
Practice Address - Fax:301-698-1848
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD113471223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD760431OtherUNITED CONCORDIA
MD760431OtherUNITED CONCORDIA
MDU46899Medicare UPIN