Provider Demographics
NPI:1710011887
Name:ITKOFF, DAVID A (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:ITKOFF
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 1:4730 W BROAD ST
Mailing Address - Street 2:LINCOLN VILLAGE PLAZA
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-1613
Mailing Address - Country:US
Mailing Address - Phone:614-878-9292
Mailing Address - Fax:
Practice Address - Street 1:4730 W BROAD ST
Practice Address - Street 2:LINCOLN VILLAGE PLAZA
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1613
Practice Address - Country:US
Practice Address - Phone:614-878-9292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH130951223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry