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General NPI Number Information
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NPI Number | 1356540231
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Entity Type | Organization
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Legal Business Name | LESLIE M. PITTS, DMD, PEDIATRIC DENTISTRY, PC
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 07/12/2007
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Provider Practice Location Address
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Address Line | 215 MERCER PL
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City | COMMERCE
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State | GA
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Zip | 30529-1564
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Country | US
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Telephone | 706-335-7793
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Fax | 706-335-7815
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Provider Business Mailing Address
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Address Line | PO BOX 1241
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City | COMMERCE
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State | GA
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Zip | 30529-0023
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Country | US
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Telephone | 706-335-7793
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Fax | 706-335-7815
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LESLIE M PITTS
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Credential | DMD
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Telephone | 706-335-7793
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN013095
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License Number State | GA
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