MEDICARE: DR. LARISA SPIRTOVIC DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019-027916	IL

General Provider Information

NPI Number	:	1447485362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARISA SPIRTOVIC DDS

Provider Business Mailing Address
First Line	:	7045 N HAMLIN AVE
Second Line	:
City	:	LINCOLNWOOD
State	:	IL
Zip	:	60712-2529
Country	:	US
Telephone Number	:	847-673-0711
Fax Number	:

Provider Business Practice Location Address
First Line	:	5841 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-5201
Country	:	US
Telephone Number	:	773-622-3454
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2009
Last Update Date	:	05/20/2009

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