Healthcare Provider Details

I. General information

NPI: 1558913103
Provider Name (Legal Business Name): KAITLYN LOUISE PITCHOK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2019
Last Update Date: 07/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 FRANK LAYMAN BLVD
WINTERSVILLE OH
43953-3770
US

IV. Provider business mailing address

444 FRANK LAYMAN BLVD
WINTERSVILLE OH
43953-3770
US

V. Phone/Fax

Practice location:
  • Phone: 740-264-4493
  • Fax:
Mailing address:
  • Phone: 740-264-4493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.025887
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: