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General NPI Number Information
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NPI Number | 1649617697
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Entity Type | Organization
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Legal Business Name | LADILIA TRIFUNOVIC DMD PLLC
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Dates
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Enumeration Date | 05/31/2013
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Last Update Date | 05/31/2013
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Provider Practice Location Address
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Address Line | 7800 W OAKLAND PARK BLVD SUITE E-112
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City | SUNRISE
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State | FL
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Zip | 33351-6741
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Country | US
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Telephone | 954-749-2600
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Fax |
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Provider Business Mailing Address
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Address Line | 6919 W BROWARD BLVD SUITE 133
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City | PLANTATION
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State | FL
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Zip | 33317-2902
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Country | US
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Telephone | 954-552-0828
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LADILIA TRIFUNOVIC
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Credential | DMD
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Telephone | 954-552-0828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN18492
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License Number State | FL
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