Healthcare Provider Details

I. General information

NPI: 1720438476
Provider Name (Legal Business Name): DJOROVIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 EVERGREEN LN
SCHERERVILLE IN
46375-1156
US

IV. Provider business mailing address

920 EVERGREEN LN
SCHERERVILLE IN
46375-1156
US

V. Phone/Fax

Practice location:
  • Phone: 219-512-2101
  • Fax:
Mailing address:
  • Phone: 219-512-2101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12012475A
License Number StateIN

VIII. Authorized Official

Name: NIKOLA DJOROVIC
Title or Position: DENTIST
Credential: DDS
Phone: 219-512-2101