Healthcare Provider Details

I. General information

NPI: 1508796665
Provider Name (Legal Business Name): KATARINA SURJANCEV DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6154 159TH ST
OAK FOREST IL
60452-2906
US

IV. Provider business mailing address

1783 W WINDMILL CT
ADDISON IL
60101-1865
US

V. Phone/Fax

Practice location:
  • Phone: 708-687-0100
  • Fax:
Mailing address:
  • Phone: 630-457-7974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.037246
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: