Provider Demographics
NPI:1194911008
Name:GHETIYA, SANJAY J (DMD)
Entity type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:J
Last Name:GHETIYA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3191 MAGUIRE BLVD. SUITE #251
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4637
Mailing Address - Country:US
Mailing Address - Phone:407-894-1451
Mailing Address - Fax:
Practice Address - Street 1:3191 MAGUIRE BLVD. SUITE #251
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4637
Practice Address - Country:US
Practice Address - Phone:407-894-1451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18046122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist