Provider Demographics
NPI:1124168489
Name:DJORDEVIC, SLOBODAN (DDS)
Entity type:Individual
Prefix:DR
First Name:SLOBODAN
Middle Name:
Last Name:DJORDEVIC
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:553 N PACIFIC COAST HWY STE D
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-2168
Mailing Address - Country:US
Mailing Address - Phone:310-318-5442
Mailing Address - Fax:310-318-1064
Practice Address - Street 1:553 N PACIFIC COAST HWY STE D
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-2168
Practice Address - Country:US
Practice Address - Phone:310-318-5442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA428171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice