Provider Demographics
NPI:1851588057
Name:KRAJCOVIC, LESLIE (BS DMD PA)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:KRAJCOVIC
Suffix:
Gender:M
Credentials:BS DMD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 E GIBSON ST
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:FL
Mailing Address - Zip Code:34266
Mailing Address - Country:US
Mailing Address - Phone:863-494-1302
Mailing Address - Fax:863-494-7221
Practice Address - Street 1:930 E GIBSON ST
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266
Practice Address - Country:US
Practice Address - Phone:863-494-1302
Practice Address - Fax:863-494-7221
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL111051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice