Healthcare Provider Details

I. General information

NPI: 1447485362
Provider Name (Legal Business Name): LARISA SPIRTOVIC DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 05/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 W BELMONT AVE
CHICAGO IL
60634-5201
US

IV. Provider business mailing address

7045 N HAMLIN AVE
LINCOLNWOOD IL
60712-2529
US

V. Phone/Fax

Practice location:
  • Phone: 773-622-3454
  • Fax:
Mailing address:
  • Phone: 847-673-0711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019-027916
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: