Healthcare Provider Details

I. General information

NPI: 1356540231
Provider Name (Legal Business Name): LESLIE M. PITTS, DMD, PEDIATRIC DENTISTRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 MERCER PL
COMMERCE GA
30529-1564
US

IV. Provider business mailing address

PO BOX 1241
COMMERCE GA
30529-0023
US

V. Phone/Fax

Practice location:
  • Phone: 706-335-7793
  • Fax: 706-335-7815
Mailing address:
  • Phone: 706-335-7793
  • Fax: 706-335-7815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDN013095
License Number StateGA

VIII. Authorized Official

Name: DR. LESLIE M PITTS
Title or Position: PRESIDENT
Credential: DMD
Phone: 706-335-7793