Provider Demographics
NPI:1992087068
Name:STANISIC, LJILJANA (DMD)
Entity type:Individual
Prefix:DR
First Name:LJILJANA
Middle Name:
Last Name:STANISIC
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WHEATLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-9622
Mailing Address - Country:US
Mailing Address - Phone:347-583-0624
Mailing Address - Fax:
Practice Address - Street 1:1 WHEATLEY BLVD
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-9622
Practice Address - Country:US
Practice Address - Phone:856-223-0041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02478100122300000X, 1223G0001X
PADS0387611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist