Provider Demographics
NPI:1033108865
Name:LJALJEVIC-TUCAKOVIC, ALMA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALMA
Middle Name:
Last Name:LJALJEVIC-TUCAKOVIC
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S. PRESTON ST.
Mailing Address - Street 2:RM 122
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40292
Mailing Address - Country:US
Mailing Address - Phone:502-852-5103
Mailing Address - Fax:502-852-5128
Practice Address - Street 1:401 E. CHESTNUT ST.
Practice Address - Street 2:STE. 550
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-852-5401
Practice Address - Fax:502-852-7602
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY78581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60001617Medicaid
KY15873Medicaid