Active NPI
Jelena Bulatovic
- Dentist
- Casa Grande, AZ
National Provider Identifier
1023626520
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019032776
- Practice address
- 865 N Arizola Rd
Casa Grande, AZ 85122-6011 - Phone
- (520) 836-3446
- NPI assigned
- Jul 21, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019032776 | IL | Primary |
Addresses
Primary practice location
865 N Arizola Rd
Casa Grande, AZ 85122-6011
Mailing address
PO Box 10097
Casa Grande, AZ 85130-0020
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019032776 | IL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sun Life Family Health Center, Inc. | Single Specialty | Past | Accepting new patients |
| Dental Experts, LLC | Single Specialty | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Federally Qualified Health Center (FQHC)
- Eloy, AZ
- NPI 1588876429
Single Specialty
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1595289600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670457600000",
"number": "1023626520",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 10097",
"city": "CASA GRANDE",
"state": "AZ",
"postal_code": "851300020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "865 N ARIZOLA RD",
"city": "CASA GRANDE",
"state": "AZ",
"postal_code": "851226011",
"telephone_number": "520-836-3446"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BULATOVIC",
"first_name": "JELENA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-07-21",
"last_updated": "2022-12-08",
"certification_date": "2022-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist",
"state": "IL",
"license": "019032776",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Casa Grande, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.