Provider Demographics
NPI:1346380888
Name:MITROVIC, DAMIR (DDS)
Entity type:Individual
Prefix:
First Name:DAMIR
Middle Name:
Last Name:MITROVIC
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 W BRIAR PL
Mailing Address - Street 2:7
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4775
Mailing Address - Country:US
Mailing Address - Phone:773-477-6507
Mailing Address - Fax:773-477-6507
Practice Address - Street 1:2334 W LAWRENCE AVE
Practice Address - Street 2:208
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1948
Practice Address - Country:US
Practice Address - Phone:773-334-4567
Practice Address - Fax:773-334-4537
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0248691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice