Jonathan M. Nitisusanta, DDS

Dentist · Ocoee, FL

Individual Active NPI

NPI number 1134283252

Practice location

2704 Rew Cir
Suite103
Ocoee, FL 34761-2994
Phone
(407) 877-9003

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NPI record

NPI
1134283252
Entity type
Individual (Type 1)
Enumeration date
December 21, 2006
Last updated
July 8, 2007
Sole proprietor
Yes

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Dentist Primary 122300000X DN13138 FL

Mailing address

10048 Brandon Cir
Orlando, FL 32836-3714
Phone
(407) 877-9003

About Dr. Nitisusanta

Jonathan M. Nitisusanta, DDS is a healthcare provider registered in the NPI registry with the primary taxonomy Dentist (code 122300000X). The practice location is 2704 Rew Cir, Suite103, Ocoee, FL 34761-2994. The NPI number 1134283252 was assigned on December 21, 2006 and the record was last updated on July 8, 2007.

Dr. Nitisusanta lists a license in the registry: #DN13138 (FL) for Dentist. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Jonathan M. Nitisusanta, DDS?

The NPI number is 1134283252.

What is the phone number of Dr. Nitisusanta?

The phone number listed for the practice location is (407) 877-9003.

Where is Dr. Nitisusanta located?

2704 Rew Cir, Suite103, Ocoee, FL 34761-2994.

What is the taxonomy code for Dr. Nitisusanta?

The primary taxonomy code is 122300000X – Dentist.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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