Perdido Bay Dental PA

Primary specialty

DentistTaxonomy code 122300000X

License

DN12887 Issued in FL

Legal business name

PERDIDO BAY DENTAL PA

Practice address

12950 Lillian Hwy
Pensacola, FL 32506-8423

Phone

(850) 542-4428

Fax

(850) 607-7515

NPI assigned

Jan 20, 2015

Last updated

Jan 20, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Slavoljub Djuric, D.D.S.

Title

President

Phone

(850) 542-4428

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1421712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421712000000",
    "number": "1225427818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12950 LILLIAN HWY",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325068423",
            "telephone_number": "850-542-4428",
            "fax_number": "850-607-7515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12950 LILLIAN HWY",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325068423",
            "telephone_number": "850-542-4428",
            "fax_number": "850-607-7515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERDIDO BAY DENTAL PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-20",
        "last_updated": "2015-01-20",
        "status": "A",
        "authorized_official_last_name": "DJURIC",
        "authorized_official_first_name": "SLAVOLJUB",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "850-542-4428",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN12887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Laquetta Delores Peoples, ED. S.
• John Angelo Perciballi, M.D.
• Perdido Bay Family Care, LLC
• Perdido Counseling Professionals, Inc.
• Perdido Dental Associates, PA
• Ruben Jesus Perdomo, CRNA
• Amanda Perdue, APRN, FNP-BC

• Dentist in Pensacola, FL
• Providers in Pensacola, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.