Provider Demographics
NPI:1689688939
Name:DIMITRIJEVIC, SINISA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SINISA
Middle Name:
Last Name:DIMITRIJEVIC
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 1:12500 INDIAN ROCKS RD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-3007
Mailing Address - Country:US
Mailing Address - Phone:727-596-4240
Mailing Address - Fax:727-596-7274
Practice Address - Street 1:12500 INDIAN ROCKS RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-3007
Practice Address - Country:US
Practice Address - Phone:727-596-4240
Practice Address - Fax:727-596-7274
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL114401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice