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General NPI Number Information
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NPI Number | 1043096159
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Entity Type | Organization
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Legal Business Name | STIVEN MITA DMD LLC
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Dates
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Enumeration Date | 09/05/2023
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 2438 BROWN ST UNIT 1
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City | PHILADELPHIA
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State | PA
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Zip | 19130-1932
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Country | US
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Telephone | 215-236-6200
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Fax | 215-236-2377
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Provider Business Mailing Address
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Address Line | 2438 BROWN ST UNIT 1
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City | PHILADELPHIA
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State | PA
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Zip | 19130-1932
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. STIVEN MITA
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Credential | DMD
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Telephone | 267-977-4638
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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