Healthcare Provider Details

I. General information

NPI: 1447448006
Provider Name (Legal Business Name): ANGELA VALENTINA LITVAK DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 JUDGE FRAN JAMIESON WAY
VIERA FL
32940-5998
US

IV. Provider business mailing address

2575 N COURTENAY PKWY
MERRITT ISLAND FL
32953-4126
US

V. Phone/Fax

Practice location:
  • Phone: 321-639-5800
  • Fax: 321-449-5015
Mailing address:
  • Phone: 321-454-7148
  • Fax: 321-449-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN 17471
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: