Individual
MICKELLE O'NEA PITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1121 BROAD ST, SUMTER, SC 29150-1902
(803) 590-3040
Mailing address
510 DEPOT ST APT 308, COLUMBIA, SC 29201-2273
(252) 525-8365
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9163
SC
1223G0001X
General Practice Dentistry
DGD9163GD
SC
Other
Enumeration date
07/03/2018
Last updated
05/01/2020
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