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NPI Code Detail

MEDICARE: DR. BOBBY TERON PITTMAN JR. DDS

MEDICARE: DR. BOBBY TERON PITTMAN JR. DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryDN013164GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154498145
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BOBBY TERON PITTMAN JR. DDS
Provider Business Mailing Address
First Line : 2788 BAYARD ST
Second Line :
City : EAST POINT
State : GA
Zip : 30344-3441
Country : US
Telephone Number : 770-407-8700
Fax Number :
Provider Business Practice Location Address
First Line : 4458 JONESBORO RD
Second Line :
City : FOREST PARK
State : GA
Zip : 30297-4314
Country : US
Telephone Number : 678-904-5665
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2006
Last Update Date : 06/18/2014

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