MEDICARE: DR. CLINT EUGENE PITT D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	6207	OK

General Provider Information

NPI Number	:	1275854846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLINT EUGENE PITT D.D.S.

Provider Business Mailing Address
First Line	:	1701 S MORGAN RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73128-7005
Country	:	US
Telephone Number	:	405-494-7799
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 S MORGAN RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73128-7005
Country	:	US
Telephone Number	:	405-494-7799
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2010
Last Update Date	:	06/16/2023

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