MEDICARE: DR. CARL EUGENE PITTMAN 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
1	1223P0221X	Pediatric Dentistry	18043	TX

General Provider Information

NPI Number	:	1558412890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARL EUGENE PITTMAN DDS

Provider Business Mailing Address
First Line	:	9316 LOUETTA RD
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-6520
Country	:	US
Telephone Number	:	281-376-2706
Fax Number	:	281-357-1847

Provider Business Practice Location Address
First Line	:	9316 LOUETTA RD
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-6520
Country	:	US
Telephone Number	:	281-376-2706
Fax Number	:	281-357-1847

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

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	07/08/2007

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