Healthcare Provider Details

I. General information

NPI: 1104712439
Provider Name (Legal Business Name): FILIP GRDIC DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2025
Last Update Date: 06/13/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6882 GULFPORT BLVD S
SOUTH PASADENA FL
33707-2108
US

IV. Provider business mailing address

201 17TH ST S APT 1220
SAINT PETERSBURG FL
33712-1742
US

V. Phone/Fax

Practice location:
  • Phone: 727-384-9655
  • Fax:
Mailing address:
  • Phone: 440-829-4006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN30480
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: