Healthcare Provider Details

I. General information

NPI: 1568045490
Provider Name (Legal Business Name): TITOV DENTAL, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 04/29/2021
Certification Date: 04/01/2021
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:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. EVGENY TITOV
Title or Position: DENTIST/OWNER
Credential: DMD
Phone: 352-727-2172