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NPI Code Detail

MEDICARE: B. MADZAREVIC, D.D.S., INC.

MEDICARE: B. MADZAREVIC, D.D.S., INC.
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
1261QD0000XDental Clinic/CenterCA31057CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11639340425OTHERCAPERSONAL/INDIVIDUAL

General Provider Information

NPI Number : 1659777266
Entity Type Code : Organization
Provider Name (Legal Business Name) : B. MADZAREVIC, D.D.S., INC.
Provider Business Mailing Address
First Line : 8840 MORRO RD
Second Line :
City : ATASCADERO
State : CA
Zip : 93422-3953
Country : US
Telephone Number : 805-462-8710
Fax Number :
Provider Business Practice Location Address
First Line : 8840 MORRO RD
Second Line :
City : ATASCADERO
State : CA
Zip : 93422-3953
Country : US
Telephone Number : 805-462-8710
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. BRANISLAV MADZAREVIC
Credential : DDS
Telephone Number : 805-462-8710
Provider Enumeration Date : 11/08/2014
Last Update Date : 11/08/2014

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