MEDICARE: DR. N. GENE PITTMAN D.D.S.

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	5001886	WI

General Provider Information

NPI Number	:	1902937527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. N. GENE PITTMAN D.D.S.

Provider Business Mailing Address
First Line	:	N88W17001 MAIN ST
Second Line	:
City	:	MENOMONEE FALLS
State	:	WI
Zip	:	53051-2828
Country	:	US
Telephone Number	:	262-251-6070
Fax Number	:	262-250-9000

Provider Business Practice Location Address
First Line	:	N88W17001 MAIN ST
Second Line	:
City	:	MENOMONEE FALLS
State	:	WI
Zip	:	53051-2828
Country	:	US
Telephone Number	:	262-251-6070
Fax Number	:	262-250-9000

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

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

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