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General NPI Number Information
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NPI Number | 1346220530
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Entity Type | Individual
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Provider Name | DEIRDRE LONG PITTMAN D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 08/23/2011
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Provider Practice Location Address
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Address Line | 205 TOWNE CENTER BLVD
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City | SANFORD
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State | FL
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Zip | 32771-7405
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Country | US
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Telephone | 407-330-3601
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Fax | 407-330-3021
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Provider Business Mailing Address
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Address Line | 205 TOWNE CENTER BLVD
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City | SANFORD
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State | FL
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Zip | 32771-7405
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Country | US
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Telephone | 407-330-3601
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Fax | 407-330-3021
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN17275
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License Number State | FL
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