MJ Dental Services, PA

Primary specialty

DentistTaxonomy code 122300000X

License

DN18726 Issued in FL

Legal business name

MJ DENTAL SERVICES, PA

Practice address

2230 West Old Highway 441
Mount Dora, FL 32757-3508

Phone

(352) 383-2959

Fax

(352) 735-3355

NPI assigned

Feb 7, 2011

Last updated

Feb 7, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Mitesh Jivan, DMDNPI 1154559334

Title

President

Phone

(352) 383-2959

Specialties & licenses 6

Addresses

Other names 1

• Mitesh Jivan DMD Other name

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mitesh Jivan, D.M.D.

  • Dentist
  • Mount Dora, FL
  • NPI 1154559334
  NPD (past) Authorized official
• Joan Lenze, D.D.S.

  • Dentist
  • Mount Dora, FL
  • NPI 1598871477
  NPD (past)

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

{
    "created_epoch": "1297036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297036800000",
    "number": "1659677714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2230 WEST OLD HIGHWAY 441",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327573508",
            "telephone_number": "352-383-2959",
            "fax_number": "352-735-3355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2230 WEST OLD HIGHWAY 441",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327573508",
            "telephone_number": "352-383-2959",
            "fax_number": "352-735-3355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MJ DENTAL SERVICES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-07",
        "last_updated": "2011-02-07",
        "status": "A",
        "authorized_official_last_name": "JIVAN",
        "authorized_official_first_name": "MITESH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "352-383-2959",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN18726",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN6360",
            "primary": false
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dental Hygienist",
            "state": "FL",
            "license": "DH5118",
            "primary": false
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dental Hygienist",
            "state": "FL",
            "license": "DH15460",
            "primary": false
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dental Hygienist",
            "state": "FL",
            "license": "DH5702",
            "primary": false
        },
        {
            "code": "126800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dental Assistant",
            "state": "FL",
            "license": "106953",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mitesh Jivan DMD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Dentist in Mount Dora, FL
• Providers in Mount Dora, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2011; 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.