Provider Demographics
NPI:1932106689
Name:PASTUOVIC, MILAN NICHOLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MILAN
Middle Name:NICHOLAS
Last Name:PASTUOVIC
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 1:1000 N. OAK AVE.
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449
Mailing Address - Country:US
Mailing Address - Phone:715-387-5511
Mailing Address - Fax:715-387-5240
Practice Address - Street 1:1000 N. OAK AVE.
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449
Practice Address - Country:US
Practice Address - Phone:715-387-5511
Practice Address - Fax:715-387-5240
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5366-0151223S0112X
IL1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI84811Medicare UPIN