Provider Demographics
NPI:1942612965
Name:D. MIKE CVETKOVIC, D.D.S., P.C.
Entity Type:Organization
Organization Name:D. MIKE CVETKOVIC, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:D.
Authorized Official - Middle Name:MIKE
Authorized Official - Last Name:CVETKOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-783-1100
Mailing Address - Street 1:6686 JOLIET RD
Mailing Address - Street 2:
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-4575
Mailing Address - Country:US
Mailing Address - Phone:708-783-1100
Mailing Address - Fax:708-783-1101
Practice Address - Street 1:6686 JOLIET RD
Practice Address - Street 2:
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525-4575
Practice Address - Country:US
Practice Address - Phone:708-783-1100
Practice Address - Fax:708-783-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-25
Last Update Date:2014-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019019648261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental