Healthcare Provider Details

I. General information

NPI: 1013322775
Provider Name (Legal Business Name): SARA MARKOVIC D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 CENTER DR
GAINESVILLE FL
32610-0436
US

IV. Provider business mailing address

1395 CENTER DR
GAINESVILLE FL
32610-0436
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-5430
  • Fax:
Mailing address:
  • Phone: 352-273-5430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDRP1569
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019030150
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: