Provider Demographics
NPI:1750942058
Name:MILICEVIC, MILICA MINA (DMD)
Entity type:Individual
Prefix:MRS
First Name:MILICA
Middle Name:MINA
Last Name:MILICEVIC
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MILICA
Other - Middle Name:MINA
Other - Last Name:GOLUBOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:3116 OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402
Mailing Address - Country:US
Mailing Address - Phone:630-244-2132
Mailing Address - Fax:
Practice Address - Street 1:3116 OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:BERYN
Practice Address - State:IL
Practice Address - Zip Code:60402
Practice Address - Country:US
Practice Address - Phone:872-256-2616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.032178122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist