Healthcare Provider Details

I. General information

NPI: 1396329843
Provider Name (Legal Business Name): TITOV DENTAL PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6654 COLLIER BLVD UNIT 104
NAPLES FL
34114-8179
US

IV. Provider business mailing address

6654 COLLIER BLVD UNIT 104
NAPLES FL
34114-8179
US

V. Phone/Fax

Practice location:
  • Phone: 239-331-3575
  • Fax:
Mailing address:
  • Phone: 239-331-3575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. EVGENY TITOV
Title or Position: OWNER/DENTIST
Credential: DMD
Phone: 239-331-3575