Boban Fidanoski, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN015383 Issued in GA

Practice address

1150 Whitlock Ave NW
Marietta, GA 30064-1933

Phone

(770) 338-3389

NPI assigned

Jul 15, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Fidanoski Dentistry, LLC

  • Dental Clinic/Center
  • Marietta, GA
  • NPI 1144850926
  NPD Authorized official
• Brian a Bain DDS II PC

  • General Practice Dentistry
  • Carrollton, GA
  • NPI 1235593385
  NPD (past)

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

{
    "created_epoch": "1500076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580083200000",
    "number": "1669994109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 WHITLOCK AVE NW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300641933",
            "telephone_number": "770-338-3389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 WHITLOCK AVE NW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300641933",
            "telephone_number": "770-338-3389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FIDANOSKI",
        "first_name": "BOBAN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-07-15",
        "last_updated": "2020-01-27",
        "certification_date": "2020-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN015383",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julia Catharine Fey
• Leanne Susan Fey, LPC
• Sabrina Fiaz, LCSW
• Fibromyalgia and Fatigue Centers, Inc.
• Fidanoski Dentistry, LLC
• Gloria Fidelis
• Fidelity Home Dialysis Corporation
• Katherine M Field, PHARMD
• Isaiha Fields, RBT
• Mackenzie Fields, RBT

• General Practice Dentistry in Marietta, GA
• Providers in Marietta, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2020; 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.