Provider Demographics
NPI:1366445363
Name:MILATOVIC, GORDANA (DDS)
Entity Type:Individual
Prefix:
First Name:GORDANA
Middle Name:
Last Name:MILATOVIC
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12640 SABRE SPRINGS PKWY
Mailing Address - Street 2:STE 103
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4113
Mailing Address - Country:US
Mailing Address - Phone:858-486-9096
Mailing Address - Fax:
Practice Address - Street 1:12640 SABRE SPRINGS PKWY
Practice Address - Street 2:STE 103
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-4113
Practice Address - Country:US
Practice Address - Phone:858-486-9096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA369811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice