Organization
DENTAL PROFILE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MILAN RONCEVIC (MANAGER)
(630) 516-0000
Entity
Organization
Contact information
Practice address
2556 W NORTH AVE, CHICAGO, IL 60647-5216
(773) 782-0014
(773) 782-8298
Mailing address
2556 W NORTH AVE, CHICAGO, IL 60647-5216
(773) 782-0014
(773) 782-8298
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/13/2008
Last updated
03/13/2008
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