MEDICARE: GIDE DENTAL IMPLANT CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics
2	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1477411254
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIDE DENTAL IMPLANT CENTER

Provider Business Mailing Address
First Line	:	12217 W PICO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1134
Country	:	US
Telephone Number	:	310-820-9641
Fax Number	:

Provider Business Practice Location Address
First Line	:	12217 W PICO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1134
Country	:	US
Telephone Number	:	310-820-9641
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. ALEKSANDAR JOVANOVIC
Credential	:	DDS
Telephone Number	:	310-820-9641

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

Similar Medicare Providers

1528226503 — DR. BEN R KAWATA DDS
Practice Location Address:

12211 W PICO BLVD
LOS ANGELES, CA
90064-1134

Practice Phone: 310-826-6123
Practice Fax: 310-207-8686

1164679809 — KAWATA DENTAL INC.
Practice Location Address:

12211 W PICO BLVD
LOS ANGELES, CA
90064-1134

Practice Phone: 310-826-6123
Practice Fax:

1568617066 — MRS. BARBARA ROCHELLE WALDMAN LMFT 42244
Practice Location Address:

1134 W. OLYMPIC BLVD. , SUITE 358
WEST LOS ANGELES, CA
90064

Practice Phone: 310-251-5327
Practice Fax: 310-455-3783

1568695922 — DR. ALEKSANDER JOVANOVIC DDS, MS
Practice Location Address:

12217 W PICO BLVD
LOS ANGELES, CA
90064-1134

Practice Phone: 310-820-9641
Practice Fax: 310-207-9025

1831571694 — DR. KRISTIN M. MORIGUCHI D.D.S.
Practice Location Address:

12211 W PICO BLVD
LOS ANGELES, CA
90064-1134

Practice Phone: 310-826-6123
Practice Fax:

1376290726 — LANI NORINE TITTLE
Practice Location Address:

12211 W PICO BLVD
LOS ANGELES, CA
90064-1134

Practice Phone: 310-826-6123
Practice Fax:

Directions to “GIDE DENTAL IMPLANT CENTER ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.