Healthcare Provider Details

I. General information

NPI: 1215072319
Provider Name (Legal Business Name): JOHN WILLIAM PITNER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5953 WESCOTT RD
COLUMBIA SC
29212-2717
US

IV. Provider business mailing address

5953 WESCOTT RD
COLUMBIA SC
29212-2717
US

V. Phone/Fax

Practice location:
  • Phone: 803-781-5225
  • Fax: 803-781-4780
Mailing address:
  • Phone: 803-781-5225
  • Fax: 803-781-4780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1444
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: