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General NPI Number Information
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NPI Number | 1558901934
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Entity Type | Individual
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Provider Name | SARA DE GRAKOVAC
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Gender | Female
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Dates
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Enumeration Date | 01/13/2020
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Last Update Date | 01/13/2020
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Provider Practice Location Address
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Address Line | 12121 WILSHIRE BLVD STE 1111
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City | LOS ANGELES
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State | CA
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Zip | 90025-1188
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Country | US
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Telephone | 310-920-9933
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Fax |
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Provider Business Mailing Address
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Address Line | 6553 WINNETKA AVE
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City | WINNETKA
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State | CA
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Zip | 91306-4247
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Country | US
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Telephone | 818-422-5686
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number | 57852
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License Number State |
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Taxonomy #2
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number | 57852
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License Number State | CA
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