Samuel Titus, DDS, MS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

12012699A Issued in IN

Practice address

515 Delaware St SE
Minneapolis, MN 55455-0357

Phone

(317) 753-5282

NPI assigned

Jun 29, 2017

Last updated

Jul 21, 2022By 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1498694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1205357357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15520 BETHESDA CIR",
            "city": "WESTFIELD",
            "state": "IN",
            "postal_code": "460748876",
            "telephone_number": "317-753-5282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 DELAWARE ST SE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554550357",
            "telephone_number": "317-753-5282"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5632 6th St NE",
            "address_purpose": "LOCATION",
            "city": "Fridley",
            "state": "MN",
            "postal_code": "55432",
            "country_code": "US",
            "telephone_number": "317-753-5282",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TITUS",
        "first_name": "SAMUEL",
        "credential": "DDS, MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-06-29",
        "last_updated": "2022-07-21",
        "certification_date": "2020-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "R675",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "IN",
            "license": "12012699A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leah Tisdale
• Roxanne Tisdale
• Sasha Marie Tisdell
• Anne Catherine Tita, M.D.
• Jamie Titus, D.C.
• Adriana Tizcareno-Zamudio, MSW, LICSW
• TJ Health Care, LLC
• Amanda Tjaden, MSN
• Moliehi Tjamela
• Sarah Elizabeth Tjernagel, MSW, LICSW

• Orthodontics and Dentofacial Orthopedics Dentistry in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.