Provider Demographics
NPI:1568045490
Name:TITOV DENTAL, P.A.
Entity Type:Organization
Organization Name:TITOV DENTAL, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
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:352-727-2172
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:
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:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental