Provider Demographics
NPI:1932694494
Name:ITTEL, JAMES A (DMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:ITTEL
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 1:5580 CORTEZ RD W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-2817
Mailing Address - Country:US
Mailing Address - Phone:941-914-9181
Mailing Address - Fax:941-914-9161
Practice Address - Street 1:5425 FRUITVILLE RD STE 16
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6418
Practice Address - Country:US
Practice Address - Phone:941-343-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN235941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice