MEDICARE: DR. ALEKSANDER JOVANOVIC DDS, MS

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	D6222	AZ

General Provider Information

NPI Number	:	1568695922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEKSANDER JOVANOVIC DDS, MS

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	:	310-207-9025

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	:	310-207-9025

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2009
Last Update Date	:	09/01/2009

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