MEDICARE: NEJLA DZAFIC DMD

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	390200000X	Student in an Organized Health Care Education/Training Program		IL

General Provider Information

NPI Number	:	1548104425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEJLA DZAFIC DMD

Provider Business Mailing Address
First Line	:	4938 N TALMAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-8109
Country	:	US
Telephone Number	:	773-747-1104
Fax Number	:

Provider Business Practice Location Address
First Line	:	4938 N TALMAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-8109
Country	:	US
Telephone Number	:	773-747-1104
Fax Number	:

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

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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