Provider Demographics
NPI:1447356167
Name:PITTS, MARK ANTHONY (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANTHONY
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 1:4409 CROSSROADS CTR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-4908
Mailing Address - Country:US
Mailing Address - Phone:614-522-0449
Mailing Address - Fax:614-522-0537
Practice Address - Street 1:4409 CROSSROADS CTR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4908
Practice Address - Country:US
Practice Address - Phone:614-522-0449
Practice Address - Fax:614-522-0537
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH19242122300000X
OH300192421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist