Provider Demographics
NPI:1811188998
Name:TOFOVIC, PETAR (DMD)
Entity Type:Individual
Prefix:
First Name:PETAR
Middle Name:
Last Name:TOFOVIC
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 1:1414 WEST CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642
Mailing Address - Country:US
Mailing Address - Phone:773-609-4483
Mailing Address - Fax:
Practice Address - Street 1:1414 WEST CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642
Practice Address - Country:US
Practice Address - Phone:773-609-4483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19027481122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist