Provider Demographics
NPI:1659863421
Name:SVJETLICA, LJILJANA
Entity type:Individual
Prefix:
First Name:LJILJANA
Middle Name:
Last Name:SVJETLICA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5461 N EAST RIVER RD APT 1210
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-1070
Mailing Address - Country:US
Mailing Address - Phone:773-580-5774
Mailing Address - Fax:
Practice Address - Street 1:5461 N EAST RIVER RD APT 1210
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-1070
Practice Address - Country:US
Practice Address - Phone:773-580-5774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019031690122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist