Provider Demographics
NPI:1225376882
Name:FAIRHOPE DENTISTRY, PC
Entity Type:Organization
Organization Name:FAIRHOPE DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SLAVOLJUB
Authorized Official - Middle Name:
Authorized Official - Last Name:DJURIC
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:251-928-9930
Mailing Address - Street 1:10939 US HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-5408
Mailing Address - Country:US
Mailing Address - Phone:251-928-9930
Mailing Address - Fax:251-928-9956
Practice Address - Street 1:10939 US HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-5408
Practice Address - Country:US
Practice Address - Phone:251-928-9930
Practice Address - Fax:251-928-9956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5894122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty