Provider Demographics
NPI:1376660100
Name:ILIC, ZORAN D
Entity Type:Individual
Prefix:
First Name:ZORAN
Middle Name:D
Last Name:ILIC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CRACKER BOX LN STE B
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-5490
Mailing Address - Country:US
Mailing Address - Phone:501-767-4600
Mailing Address - Fax:501-767-4399
Practice Address - Street 1:105 CRACKER BOX LN STE B
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-5490
Practice Address - Country:US
Practice Address - Phone:501-767-4600
Practice Address - Fax:501-767-4399
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3274122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist