Provider Demographics
NPI:1285784637
Name:SASIC LALICH, LAURA (DDS)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SASIC LALICH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17100 CAMBRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-5279
Mailing Address - Country:US
Mailing Address - Phone:708-633-9040
Mailing Address - Fax:
Practice Address - Street 1:2630 FLOSSMOOR RD STE 103
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-1560
Practice Address - Country:US
Practice Address - Phone:708-798-0990
Practice Address - Fax:708-798-3370
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190192161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice