Provider Demographics
NPI:1184930349
Name:GHOSH, JOITA (DDS)
Entity type:Individual
Prefix:
First Name:JOITA
Middle Name:
Last Name:GHOSH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12825 CASTLEMAINE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-4469
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1502 W FLETCHER AVE STE 117
Practice Address - Street 2:KEA SMILE STUDIO
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-3308
Practice Address - Country:US
Practice Address - Phone:813-968-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10351122300000X
FLDN19609122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist