Provider Demographics
NPI:1194739714
Name:MANDIC-KULJIC, NATASA (DMD)
Entity type:Individual
Prefix:DR
First Name:NATASA
Middle Name:
Last Name:MANDIC-KULJIC
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:NATASA
Other - Middle Name:
Other - Last Name:MANDIC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:900 CUMMINGS CENTER
Mailing Address - Street 2:SUITE 106T
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915
Mailing Address - Country:US
Mailing Address - Phone:978-922-4200
Mailing Address - Fax:
Practice Address - Street 1:900 CUMMINGS CENTER
Practice Address - Street 2:SUITE 106T
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915
Practice Address - Country:US
Practice Address - Phone:978-922-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA213211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice