Provider Demographics
NPI:1376823658
Name:ORA DENTAL STUDIO GOLD COAST LLC
Entity Type:Organization
Organization Name:ORA DENTAL STUDIO GOLD COAST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MLADEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRALJ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:312-867-8766
Mailing Address - Street 1:712 N DEARBORN ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-3818
Mailing Address - Country:US
Mailing Address - Phone:312-867-8766
Mailing Address - Fax:312-876-8755
Practice Address - Street 1:712 N DEARBORN ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-3818
Practice Address - Country:US
Practice Address - Phone:312-867-8766
Practice Address - Fax:312-876-8755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190228241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty