Provider Demographics
NPI:1659339893
Name:ILIC-SILJAK, SRDJAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:SRDJAN
Middle Name:
Last Name:ILIC-SILJAK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 S BRENTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-2713
Mailing Address - Country:US
Mailing Address - Phone:314-962-6622
Mailing Address - Fax:314-961-2288
Practice Address - Street 1:2915 S BRENTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63144-2713
Practice Address - Country:US
Practice Address - Phone:314-962-6622
Practice Address - Fax:314-961-2288
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080110961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice