Provider Demographics
NPI:1609662410
Name:DJORDJEVIC DENTAL PLLC
Entity type:Organization
Organization Name:DJORDJEVIC DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DJORDJEVIC
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-660-5880
Mailing Address - Street 1:16347 W 159TH ST
Mailing Address - Street 2:SDJORD@UMICH.EDU
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-6044
Mailing Address - Country:US
Mailing Address - Phone:815-660-5880
Mailing Address - Fax:
Practice Address - Street 1:16347 W 159TH ST
Practice Address - Street 2:SDJORD@UMICH.EDU
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-6044
Practice Address - Country:US
Practice Address - Phone:815-660-5880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty