Provider Demographics
NPI:1952656209
Name:KNEZEVIC, MARJANA (DMD)
Entity Type:Individual
Prefix:
First Name:MARJANA
Middle Name:
Last Name:KNEZEVIC
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 SECOND AVE
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-2608
Mailing Address - Country:US
Mailing Address - Phone:404-271-3134
Mailing Address - Fax:
Practice Address - Street 1:117 SECOND AVE
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426
Practice Address - Country:US
Practice Address - Phone:610-409-0676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039222122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist