Provider Demographics
NPI:1285787721
Name:DUZDEVICH, SLAVKO P (DDS)
Entity type:Individual
Prefix:DR
First Name:SLAVKO
Middle Name:P
Last Name:DUZDEVICH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 WEST 72ND ST. 2ND FLOOR
Mailing Address - Street 2:PROSMILE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023
Mailing Address - Country:US
Mailing Address - Phone:212-799-8040
Mailing Address - Fax:212-799-8190
Practice Address - Street 1:53 WEST 72ND ST. 2ND FLOOR
Practice Address - Street 2:PROSMILE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023
Practice Address - Country:US
Practice Address - Phone:212-799-8040
Practice Address - Fax:212-799-8190
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0402291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice