Provider Demographics
NPI:1548932999
Name:HD DENTISTRY
Entity type:Organization
Organization Name:HD DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIJA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-715-8035
Mailing Address - Street 1:1150 E GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5348
Mailing Address - Country:US
Mailing Address - Phone:602-944-4123
Mailing Address - Fax:
Practice Address - Street 1:1150 E GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5348
Practice Address - Country:US
Practice Address - Phone:602-944-4123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental