Provider Demographics
NPI:1669633566
Name:JURICIC, PASKO (DDS)
Entity Type:Individual
Prefix:DR
First Name:PASKO
Middle Name:
Last Name:JURICIC
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16655 15 MILE RD
Mailing Address - Street 2:STE. A
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-5522
Mailing Address - Country:US
Mailing Address - Phone:586-791-2100
Mailing Address - Fax:
Practice Address - Street 1:16655 15 MILE RD
Practice Address - Street 2:STE. A
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035-5522
Practice Address - Country:US
Practice Address - Phone:586-791-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI17074122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist