Healthcare Provider Details

I. General information

NPI: 1407801244
Provider Name (Legal Business Name): SLAVOLJUB DJURIC DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 10/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 E TEN MILE RD
PENSACOLA FL
32534-9712
US

IV. Provider business mailing address

461 E TEN MILE RD
PENSACOLA FL
32534-9712
US

V. Phone/Fax

Practice location:
  • Phone: 850-474-0038
  • Fax: 850-474-0055
Mailing address:
  • Phone: 850-474-0038
  • Fax: 850-474-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN12887
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: