Jonathan M Nitisusanta, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DN13138 Issued in FL

Practice address

2704 Rew Cir
Suite103
Ocoee, FL 34761-2994

Phone

(407) 877-9003

NPI assigned

Dec 21, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Networks

• Freedom Health HMO Network

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1134283252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10048 BRANDON CIR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328363714",
            "telephone_number": "407-877-9003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2704 REW CIR",
            "address_2": "SUITE103",
            "city": "OCOEE",
            "state": "FL",
            "postal_code": "347612994",
            "telephone_number": "407-877-9003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NITISUSANTA",
        "first_name": "JONATHAN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN13138",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sam Nguyen
• Thien Nguyen, PHARMD
• Trista Trinh Nguyen
• Nichi Enterprises Inc (Central Florida Personal Injury & Sports Medicine)
• Tammy Virginia Nieves, MA, CCC-SLP
• Nadine Nitisusanta, DMD
• No Limits Housing Solutions, LLC (No Limits Affordable Home Care Solutions, LLC)
• Kamaya Marie Nombre
• Alexis Nicole Noroski
• Crystal Elaine Norwood, RN

• Dentist in Ocoee, FL
• Providers in Ocoee, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.