MEDICARE: DR. RYAN PITMAN D.M.D.

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	D9337	WA

General Provider Information

NPI Number	:	1447370176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN PITMAN D.M.D.

Provider Business Mailing Address
First Line	:	1101 SE TECH CENTER DR
Second Line	:	SUITE 195
City	:	VANCOUVER
State	:	WA
Zip	:	98683-5504
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8700 NE VANCOUVER MALL DR
Second Line	:	SUITE 202
City	:	VANCOUVER
State	:	WA
Zip	:	98662-6750
Country	:	US
Telephone Number	:	360-254-8880
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/08/2007

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