=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104712439
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FILIP GRDIC DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2025
-----------------------------------------------------
Last Update Date | 06/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6882 GULFPORT BLVD S
-----------------------------------------------------
City | SOUTH PASADENA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33707-2108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-384-9655
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 17TH ST S APT 1220
-----------------------------------------------------
City | SAINT PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33712-1742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-829-4006
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DN30480
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------