MEDICARE: CLINT PITT, D.D.S., P.C.

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
1	1223G0001X	General Practice Dentistry	6207	OK

General Provider Information

NPI Number	:	1265773071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINT PITT, D.D.S., P.C.

Provider Business Mailing Address
First Line	:	3212 CHESTERFIELD PL
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73179-6009
Country	:	US
Telephone Number	:	405-323-5366
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 S MORGAN RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73128-7005
Country	:	US
Telephone Number	:	405-323-5366
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CLINT EUGENE PITT
Credential	:	D.D.S.
Telephone Number	:	405-323-5366

Provider Enumeration Date	:	03/05/2013
Last Update Date	:	03/14/2013

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