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General NPI Number Information
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NPI Number | 1922535426
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Entity Type | Individual
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Provider Name | MARIJA MITIC DDS
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Gender | Female
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Dates
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Enumeration Date | 05/15/2017
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 125 W MCDOWELL RD STE B
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City | PHOENIX
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State | AZ
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Zip | 85003-1223
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Country | US
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Telephone | 480-828-7563
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Fax |
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Provider Business Mailing Address
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Address Line | 125 W MCDOWELL RD STE B
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City | PHOENIX
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State | AZ
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Zip | 85003-1223
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Country | US
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Telephone | 480-828-7563
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DE60750233
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License Number State | WA
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