Provider Demographics
NPI:1326772534
Name:CVETKOVIC, SAMUILO (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMUILO
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 1:3316 W BERTEAU AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-2306
Mailing Address - Country:US
Mailing Address - Phone:773-526-9830
Mailing Address - Fax:
Practice Address - Street 1:5250 N LINCOLN AVE STE 3G
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3963
Practice Address - Country:US
Practice Address - Phone:773-334-9004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.033887122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist