1891132965 NPI number — TRACY LEE PITTMAN DENTAL HYGIENIST

Table of content: TRACY LEE PITTMAN DENTAL HYGIENIST (NPI 1891132965)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891132965 NPI number — TRACY LEE PITTMAN DENTAL HYGIENIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PITTMAN
Provider First Name:
TRACY
Provider Middle Name:
LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DENTAL HYGIENIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEONE
Provider Other First Name:
TRACY
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891132965
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5095 RIFLE RIVER TRAIL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALGER
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-873-5152
Provider Business Mailing Address Fax Number:
989-873-5913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
STERLING AREA DENTAL OFFICE
Provider Second Line Business Practice Location Address:
5095 RIFLE RIVER TRAIL
Provider Business Practice Location Address City Name:
ALGER
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-873-5152
Provider Business Practice Location Address Fax Number:
989-873-5913
Provider Enumeration Date:
05/30/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 124Q00000X , with the licence number:  2902013094 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)