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General NPI Number Information
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NPI Number | 1346380888
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Entity Type | Individual
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Provider Name | DAMIR MITROVIC DDS
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Gender | Male
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 10/06/2015
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Provider Practice Location Address
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Address Line | 2334 W LAWRENCE AVE 208
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City | CHICAGO
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State | IL
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Zip | 60625-1948
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Country | US
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Telephone | 773-334-4567
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Fax | 773-334-4537
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Provider Business Mailing Address
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Address Line | 434 W BRIAR PL 7
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City | CHICAGO
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State | IL
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Zip | 60657-4775
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Country | US
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Telephone | 773-477-6507
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Fax | 773-477-6507
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019-024869
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License Number State | IL
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