Healthcare Provider Details

I. General information

NPI: 1760830558
Provider Name (Legal Business Name): PITNER ORTHODONTICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 06/02/2016
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: 803-470-3697
Mailing address:
  • Phone: 803-781-5225
  • Fax: 803-470-3697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3905
License Number StateSC

VIII. Authorized Official

Name: DR. LESLIE PITNER
Title or Position: OWNER/ORTHODONTIST
Credential: D.D.S.
Phone: 803-781-5225