Provider Demographics
NPI:1538699699
Name:ALAGIC, VANJA (DMD)
Entity Type:Individual
Prefix:
First Name:VANJA
Middle Name:
Last Name:ALAGIC
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 3RD ST S UNIT 1117
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4272
Mailing Address - Country:US
Mailing Address - Phone:727-259-4654
Mailing Address - Fax:
Practice Address - Street 1:4030 PARK BLVD N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3633
Practice Address - Country:US
Practice Address - Phone:727-341-5171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN22721122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist