Provider Demographics
NPI:1558538108
Name:CVETKOVIC, STEVAN (DDS)
Entity Type:Individual
Prefix:
First Name:STEVAN
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 1:5250 NORTH LINCOLN AVE
Mailing Address - Street 2:UNIT G-3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625
Mailing Address - Country:US
Mailing Address - Phone:773-334-9004
Mailing Address - Fax:
Practice Address - Street 1:5250 NORTH LINCOLN AVE
Practice Address - Street 2:UNIT G-3
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625
Practice Address - Country:US
Practice Address - Phone:773-334-9004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019024225122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist