Provider Demographics
NPI:1568524858
Name:RADOSAVLJEVIC, NATASA (DDS)
Entity Type:Individual
Prefix:
First Name:NATASA
Middle Name:
Last Name:RADOSAVLJEVIC
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 1:25400 US HIGHWAY 19 N
Mailing Address - Street 2:SUITE #199
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-2149
Mailing Address - Country:US
Mailing Address - Phone:727-796-2427
Mailing Address - Fax:727-796-2428
Practice Address - Street 1:25400 US HIGHWAY 19 N
Practice Address - Street 2:SUITE #199
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-2149
Practice Address - Country:US
Practice Address - Phone:727-796-2427
Practice Address - Fax:727-796-2428
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN175791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice