Provider Demographics
NPI:1821607524
Name:AVDIC, ANELA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANELA
Middle Name:
Last Name:AVDIC
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ANELA
Other - Middle Name:
Other - Last Name:CUFUROVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-2326
Mailing Address - Country:US
Mailing Address - Phone:313-969-2361
Mailing Address - Fax:
Practice Address - Street 1:22972 LAHSER RD STE 1
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-4408
Practice Address - Country:US
Practice Address - Phone:248-368-0684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016006531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice