Provider Demographics
NPI:1396329843
Name:TITOV DENTAL PA
Entity type:Organization
Organization Name:TITOV DENTAL PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EVGENY
Authorized Official - Middle Name:
Authorized Official - Last Name:TITOV
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:239-331-3575
Mailing Address - Street 1:6654 COLLIER BLVD UNIT 104
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34114-8179
Mailing Address - Country:US
Mailing Address - Phone:239-331-3575
Mailing Address - Fax:
Practice Address - Street 1:6654 COLLIER BLVD UNIT 104
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34114-8179
Practice Address - Country:US
Practice Address - Phone:239-331-3575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-11
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty