Provider Demographics
NPI:1679691307
Name:PITTMAN, CAROL A (DDS)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 E 82ND ST STE 104
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-4749
Mailing Address - Country:US
Mailing Address - Phone:371-931-0480
Mailing Address - Fax:
Practice Address - Street 1:4025 E 82ND ST STE 104
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-4749
Practice Address - Country:US
Practice Address - Phone:317-913-0480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014116571223G0001X
IN12011106A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice