Provider Demographics
NPI:1063687077
Name:DRAKULOVIC, MILUTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MILUTIN
Middle Name:
Last Name:DRAKULOVIC
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 1:711 E CAREFREE HWY
Mailing Address - Street 2:STE 210
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-0101
Mailing Address - Country:US
Mailing Address - Phone:623-434-9868
Mailing Address - Fax:623-434-9864
Practice Address - Street 1:711 E CAREFREE HWY
Practice Address - Street 2:STE 210
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-0101
Practice Address - Country:US
Practice Address - Phone:623-434-9868
Practice Address - Fax:623-434-9864
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901016560122300000X
AZ77391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist