Healthcare Provider Details

I. General information

NPI: 1033872668
Provider Name (Legal Business Name): NATASHA OBRADOVICH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21080 ALLEN RD
WOODHAVEN MI
48183-1602
US

IV. Provider business mailing address

1218 KENWICK WAY
LASALLE ONTARIO
N9H2G7
CA

V. Phone/Fax

Practice location:
  • Phone: 734-676-1656
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901601067
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: