Provider Demographics
NPI:1447448006
Name:LITVAK, ANGELA VALENTINA (DMD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:VALENTINA
Last Name:LITVAK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 N COURTENAY PKWY
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4126
Mailing Address - Country:US
Mailing Address - Phone:321-454-7148
Mailing Address - Fax:321-449-5015
Practice Address - Street 1:2555 JUDGE FRAN JAMIESON WAY
Practice Address - Street 2:
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940-5998
Practice Address - Country:US
Practice Address - Phone:321-639-5800
Practice Address - Fax:321-449-5015
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 174711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice