Provider Demographics
NPI:1104979707
Name:MARSHALL S HUMES DDS ANTHONY PITROWSKI MD DMD INC
Entity type:Organization
Organization Name:MARSHALL S HUMES DDS ANTHONY PITROWSKI MD DMD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:SHERIDAN
Authorized Official - Last Name:HUMES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-928-7611
Mailing Address - Street 1:201 N COLLEGE DRIVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454
Mailing Address - Country:US
Mailing Address - Phone:805-928-7611
Mailing Address - Fax:805-349-8551
Practice Address - Street 1:201 N COLLEGE DR
Practice Address - Street 2:202
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4614
Practice Address - Country:US
Practice Address - Phone:805-928-7611
Practice Address - Fax:805-349-8551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA272971223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty