Provider Demographics
NPI:1003595133
Name:STEVANOVIC, RADMILA (DDS)
Entity Type:Individual
Prefix:DR
First Name:RADMILA
Middle Name:
Last Name:STEVANOVIC
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 SANDPEBBLE DR
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-5920
Mailing Address - Country:US
Mailing Address - Phone:901-277-3905
Mailing Address - Fax:
Practice Address - Street 1:1 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2432
Practice Address - Country:US
Practice Address - Phone:708-948-7744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.034515122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist