Provider Demographics
NPI:1710082300
Name:MOTWANI, RAJIV (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAJIV
Middle Name:
Last Name:MOTWANI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 US HIGHWAY 301 N
Mailing Address - Street 2:
Mailing Address - City:ELLENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34222-2010
Mailing Address - Country:US
Mailing Address - Phone:941-722-0502
Mailing Address - Fax:941-722-3634
Practice Address - Street 1:3030 US HIGHWAY 301 N
Practice Address - Street 2:
Practice Address - City:ELLENTON
Practice Address - State:FL
Practice Address - Zip Code:34222-2010
Practice Address - Country:US
Practice Address - Phone:941-722-0502
Practice Address - Fax:941-722-3634
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN167921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice