Provider Demographics
NPI:1467491084
Name:GITTESS, RANDY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:L
Last Name:GITTESS
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 1:5733 CANTON CV
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-5079
Mailing Address - Country:US
Mailing Address - Phone:407-699-1200
Mailing Address - Fax:407-699-1095
Practice Address - Street 1:5733 CANTON CV
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-5079
Practice Address - Country:US
Practice Address - Phone:407-699-1200
Practice Address - Fax:407-699-1095
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00074941223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics