Individual
DR. TYLER LANE PITTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1740 EUCLID AVE, BRISTOL, VA 24201-3736
(276) 466-2028
(276) 466-1629
Mailing address
1740 EUCLID AVE, BRISTOL, VA 24201-3736
(276) 466-2028
(276) 466-1629
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401410222
VA
1223G0001X
General Practice Dentistry
DS0000007776
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
061550
BCBS OF VA
VA
01
—
1300698
UNITED CONCORDIA
VA
01
—
3158606
BCBS OF TN
TN
Enumeration date
10/04/2006
Last updated
07/08/2007
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