Provider Demographics
NPI:1053357343
Name:HITTLE, STEPHEN E (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:E
Last Name:HITTLE
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 1:8471 FORT SMALLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-2738
Mailing Address - Country:US
Mailing Address - Phone:410-255-6611
Mailing Address - Fax:410-437-4371
Practice Address - Street 1:8471 FORT SMALLWOOD RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-2738
Practice Address - Country:US
Practice Address - Phone:410-255-6611
Practice Address - Fax:410-437-4371
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD067981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA109159OtherUNITED CONCORDIA