Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 22020 | MA |
Y | 1223P0700X | Prosthodontist | DN17952 | FL |
NPI | 1023290889 |
---|---|
Provider Name | Dr. Vladimir R Jovic |
First Address | Jacksonville Beach, FL 32250-2480 |
Second Address | Jacksonville, FL 32223-6655 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2007 |
Last Update Date | 20/01/2012 |