MEDICARE: DD PITCHER LLC

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	261QS0112X	Oral and Maxillofacial Surgery Clinic/Center	058771	NY

General Provider Information

NPI Number	:	1881146785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DD PITCHER LLC

Provider Business Mailing Address
First Line	:	30 OFFICE PARK WAY
Second Line	:
City	:	PITTSFORD
State	:	NY
Zip	:	14534-1734
Country	:	US
Telephone Number	:	585-586-9063
Fax Number	:	585-586-1478

Provider Business Practice Location Address
First Line	:	30 OFFICE PARK WAY
Second Line	:
City	:	PITTSFORD
State	:	NY
Zip	:	14534-1734
Country	:	US
Telephone Number	:	585-586-9063
Fax Number	:	585-586-1478

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. DONALD PITCHER
Credential	:	D.D.S.
Telephone Number	:	585-586-9063

Provider Enumeration Date	:	10/27/2016
Last Update Date	:	10/27/2016

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