Provider Demographics
NPI:1114130051
Name:CVETKOVIC, MIKE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MIKE
Middle Name:
Last Name:CVETKOVIC
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6686 JOLIET RD
Mailing Address - Street 2:
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-4575
Mailing Address - Country:US
Mailing Address - Phone:708-783-1100
Mailing Address - Fax:708-783-1101
Practice Address - Street 1:6686 JOLIET RD
Practice Address - Street 2:
Practice Address - City:INDIAN HEAD PARK
Practice Address - State:IL
Practice Address - Zip Code:60525
Practice Address - Country:US
Practice Address - Phone:708-783-1100
Practice Address - Fax:708-783-1101
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190196481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice