| NPI | 1659677714 |
|---|---|
| Other Name | MITESH JIVAN DMD |
| Entity Type | Organization |
| Authorized Contact | MITESH JIVAN President 352-383-2959 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN18726) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN6360) |
| 124Q00000X Dental Hygienist (Licence: FL DH5118) | |
| 124Q00000X Dental Hygienist (Licence: FL DH15460) | |
| 124Q00000X Dental Hygienist (Licence: FL DH5702) | |
| 126800000X Dental Assistant (Licence: FL 106953) | |
| Enumeration Date | 2011-02-07 |
| Last Update Date | 2011-02-07 |