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General NPI Number Information
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NPI Number | 1811186240
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Entity Type | Organization
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Legal Business Name | BRAD PITTS DMD LLC
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Dates
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Enumeration Date | 10/22/2007
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Last Update Date | 10/22/2007
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Provider Practice Location Address
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Address Line | 117 OLD CHAPIN RD
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City | LEXINGTON
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State | SC
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Zip | 29072-2005
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Country | US
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Telephone | 803-808-1778
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Fax | 803-808-1821
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Provider Business Mailing Address
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Address Line | 117 OLD CHAPIN RD
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City | LEXINGTON
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State | SC
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Zip | 29072-2005
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Country | US
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Telephone | 803-808-1778
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Fax | 803-808-1821
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Authorized Official
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Title or Position | DENTIST
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Name | DR. BRADLEY REEDER PITTS
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Credential | DMD
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Telephone | 803-808-1778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3777
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License Number State | SC
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