Healthcare Provider Details

I. General information

NPI: 1972008183
Provider Name (Legal Business Name): PREDRAG DORDEVIC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23250 VIA VILLAGIO
ESTERO FL
33928-8353
US

IV. Provider business mailing address

23250 VIA VILLAGIO
ESTERO FL
33928-8353
US

V. Phone/Fax

Practice location:
  • Phone: 239-908-0486
  • Fax:
Mailing address:
  • Phone: 239-908-0486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN25128
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: