Healthcare Provider Details

I. General information

NPI: 1679772321
Provider Name (Legal Business Name): JAMES M PITTMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12183 RICHARDSON HILL RD
FOLSOM LA
70437
US

IV. Provider business mailing address

12183 RICHARDSON HILL RD
FOLSOM LA
70437
US

V. Phone/Fax

Practice location:
  • Phone: 985-796-8500
  • Fax: 985-796-8501
Mailing address:
  • Phone: 985-796-8500
  • Fax: 985-796-8501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2248
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: