Healthcare Provider Details

I. General information

NPI: 1447279120
Provider Name (Legal Business Name): MARK ALEXANDER PITTS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6550 MERCANTILE DR E SUITE 101
FREDERICK MD
21703-7547
US

IV. Provider business mailing address

2000 DIXON RD
FREDERICK MD
21704-8137
US

V. Phone/Fax

Practice location:
  • Phone: 301-698-5208
  • Fax: 301-698-1848
Mailing address:
  • Phone: 301-874-1855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number11347
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: