Provider Demographics
NPI:1275933343
Name:JOKIC, EDA (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDA
Middle Name:
Last Name:JOKIC
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:EDA
Other - Middle Name:
Other - Last Name:METHASANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:4740 INGLEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-5824
Mailing Address - Country:US
Mailing Address - Phone:310-313-1063
Mailing Address - Fax:310-398-5681
Practice Address - Street 1:4740 INGLEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-5824
Practice Address - Country:US
Practice Address - Phone:310-313-1063
Practice Address - Fax:310-398-5681
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62873122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist