Individual
DR. JONATHAN M NITISUSANTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2704 REW CIR, SUITE103, OCOEE, FL 34761-2994
(407) 877-9003
Mailing address
10048 BRANDON CIR, ORLANDO, FL 32836-3714
(407) 877-9003
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN13138
FL
Other
Enumeration date
12/21/2006
Last updated
07/08/2007
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