Provider Demographics
NPI:1841410727
Name:ZANINOVIC, PERIZA (DDS)
Entity Type:Individual
Prefix:
First Name:PERIZA
Middle Name:
Last Name:ZANINOVIC
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 1:123 MARMONT STREET
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120
Mailing Address - Country:US
Mailing Address - Phone:512-931-2190
Mailing Address - Fax:512-869-2940
Practice Address - Street 1:123 MARMONT STREET
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120
Practice Address - Country:US
Practice Address - Phone:512-931-2190
Practice Address - Fax:512-869-2940
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201011223G0001X
CA4734721223G0001X
MI2901600691122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA47342OtherSTATE LICENSE NUMBER