Provider Demographics
NPI:1144390402
Name:MITROVIC, TATIANA M (DDS)
Entity Type:Individual
Prefix:MRS
First Name:TATIANA
Middle Name:M
Last Name:MITROVIC
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 1:7716 W 26TH STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546
Mailing Address - Country:US
Mailing Address - Phone:708-447-2266
Mailing Address - Fax:708-447-2486
Practice Address - Street 1:7716 W 26TH STREET
Practice Address - Street 2:
Practice Address - City:NORTH RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546
Practice Address - Country:US
Practice Address - Phone:708-447-2266
Practice Address - Fax:708-447-2486
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist