Provider Demographics
NPI:1063474997
Name:TITUS, DAVID S (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:TITUS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 ORCHARD LN
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3432
Mailing Address - Country:US
Mailing Address - Phone:847-441-5335
Mailing Address - Fax:847-441-5339
Practice Address - Street 1:1721 ORCHARD LN
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3432
Practice Address - Country:US
Practice Address - Phone:847-441-5335
Practice Address - Fax:847-441-5339
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice