Healthcare Provider Details

I. General information

NPI: 1952863219
Provider Name (Legal Business Name): AARON B. PITTS, DMD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 04/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28914 OLD HIGHWAY 80 STE 104
PINE VALLEY CA
91962-4411
US

IV. Provider business mailing address

28914 OLD HIGHWAY 80 STE 104
PINE VALLEY CA
91962-4411
US

V. Phone/Fax

Practice location:
  • Phone: 619-377-3006
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AARON BRIAN PITTS
Title or Position: OWNER/OPERATOR
Credential: DMD
Phone: 718-644-2754