Provider Demographics
NPI:1174535165
Name:PITTS, JON EDWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:EDWARD
Last Name:PITTS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 E FIRST ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-5218
Mailing Address - Country:US
Mailing Address - Phone:360-533-0906
Mailing Address - Fax:360-532-8516
Practice Address - Street 1:222 E FIRST ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-5218
Practice Address - Country:US
Practice Address - Phone:360-533-0906
Practice Address - Fax:360-532-8516
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3847122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5002977OtherDEPT OF SOCIAL HEALTH