Provider Demographics
NPI:1881924520
Name:ZEKIC, MLADEN (DMD)
Entity type:Individual
Prefix:
First Name:MLADEN
Middle Name:
Last Name:ZEKIC
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5336 STADIUM TRACE PKWY
Mailing Address - Street 2:SUITE 112
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-4580
Mailing Address - Country:US
Mailing Address - Phone:205-733-1599
Mailing Address - Fax:205-733-1590
Practice Address - Street 1:5336 STADIUM TRACE PKWY
Practice Address - Street 2:SUITE 112
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-4580
Practice Address - Country:US
Practice Address - Phone:205-733-1599
Practice Address - Fax:205-733-1590
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL54591223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics