Provider Demographics
NPI:1720438476
Name:DJOROVIC, INC.
Entity Type:Organization
Organization Name:DJOROVIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:NIKOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:DJOROVIC
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-512-2101
Mailing Address - Street 1:920 EVERGREEN LN
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-1156
Mailing Address - Country:US
Mailing Address - Phone:219-512-2101
Mailing Address - Fax:
Practice Address - Street 1:920 EVERGREEN LN
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-1156
Practice Address - Country:US
Practice Address - Phone:219-512-2101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012475A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty