Provider Demographics
NPI:1649340209
Name:KRALJ, MLADEN (DMD)
Entity type:Individual
Prefix:DR
First Name:MLADEN
Middle Name:
Last Name:KRALJ
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 1:937 W RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2229
Mailing Address - Country:US
Mailing Address - Phone:312-491-9494
Mailing Address - Fax:312-491-9474
Practice Address - Street 1:937 W. RANDOLPH
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-5372
Practice Address - Country:US
Practice Address - Phone:312-491-9494
Practice Address - Fax:312-491-9474
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190228241223G0001X
IL190246411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice