Healthcare Provider Details

I. General information

NPI: 1992451215
Provider Name (Legal Business Name): ANITA JIVAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9575 W TROPICANA AVE
LAS VEGAS NV
89147-8490
US

IV. Provider business mailing address

3153 MADDEN WAY
DUBLIN CA
94568-7220
US

V. Phone/Fax

Practice location:
  • Phone: 702-633-8331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberS6-231
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: