Healthcare Provider Details

I. General information

NPI: 1518980184
Provider Name (Legal Business Name): DR. DIJANA TOFOVIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 BUTLER ST
PITTSBURGH PA
15223-2124
US

IV. Provider business mailing address

369 BUTLER ST P.O. BOX 9507
PITTSBURGH PA
15223-2124
US

V. Phone/Fax

Practice location:
  • Phone: 412-784-0228
  • Fax: 412-784-0458
Mailing address:
  • Phone: 412-784-0228
  • Fax: 412-784-0458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS031390L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: