Provider Demographics
NPI:1538376009
Name:TSIVITSE, PETER J JR (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:TSIVITSE
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:672 NEEB RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45233-4619
Mailing Address - Country:US
Mailing Address - Phone:513-451-5399
Mailing Address - Fax:
Practice Address - Street 1:672 NEEB ROAD
Practice Address - Street 2:SUITE 2
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45233
Practice Address - Country:US
Practice Address - Phone:513-451-5399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice